The paper compares processes of privatization in healthcare in Spain, Israel and the US, focusing mainly on forms of public/private mix, to evaluate concretely the 'variegated' character of neo-liberalization processes. As Brenner, Peck and Theodor argue, reform processes are simultaneously patterned by global neo-liberal assumptions and conditioning, therefore interconnected; and locally specific, modulated by the institutional, historical and political characteristics of the different countries. Privatization of healthcare has three main forms, privatization of financing, of ownership and the "enterprization" of the public system, blurring the boundaries between public and private. In all countries this last dimension has turned to be the central form of privatization and represents the main threat to public health care systems. The paper analyzes the concrete institutional forms of private/public mix in the three countries. In Spain, out-sourcing of services, private-finance initiatives and the "Alcira model", all maintain relatively clear boundaries between the private and the public sectors. In Israel, the main form of public/private mix have been forms that blur the boundaries between the public and the private system: private insurance sold by the public sick funds, private for-profit hospitals owned by the public non-profit sick funds and public hospitals selling private services. In the US, recent reforms related to the Affordable Care Act are still in formation. The comparison of the processes of privatization in health care in Spain, Israel and the US, shows the ways in which the global transition to a neo-liberal model does not result in convergence but in the systemic production of geoinstitutional differentiation. It means that the responses to these forces, in order to strengthen the public healthcare system as to increase health equity and improve access to healthcare, should be sensitive to both global and local contexts and can not be designed as "one size fits all" solutions.
|State||Published - Oct 2016|