MEDICINE AND PUBLIC HEALTH AT THE END OF EMPIRE by HOWARD WAITZKIN

Author:HOWARD WAITZKIN
Language: eng
Format: epub
Publisher: Routledge

Penetration by Multinational Corporations

During empire present, policies of international financial institutions therefore fostered “reform” decisions in Mexico and Brazil that supported and expanded the role of multinational corporations based mainly in the United States. In particular, the international financial institutions advocated reforms that privatized publicsector services and opened them to corporate ownership and/or administration. The reforms encouraged a wide range of profit-making activities by managed care organizations, financed by those countries’ social security systems.

Undeniably, important problems existed in health care prior to the reforms in both countries. Lack of financial resources affected personnel, maintenance of equipment and facilities, and supply of medications. These problems led to deterioration in working conditions and in delivery of services. A decrease in public-sector resources, however, derived in large part from structural adjustment policies undertaken in the 1980s. These policies caused major reductions in health-care budgets, as well as extensive unemployment and low wages, which further reduced contributions to the social security systems.25 Corruption and inefficiency, which characterized the health systems of both countries before “reform,” did not change substantially under privatization.

The impacts of corporate managed care on health care and public health programs in Mexico and Brazil proved dramatic. These effects included restricted access for vulnerable groups of patients and reduced spending for clinical services as a result of higher spending on administration and return to investors. Because copayments required under managed care plans created barriers to access, they led to increasing use of and strain in public hospitals and clinics.26

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