This project falls within the United Nations Research Institute for Social Development (UNRISD) research on Social Policy in a Development Context, which elaborates the core principles underpinning social policy as the edification of a state-society nexus that is developmental (facilitates and promotes economic growth and structural transformation), democratic (derives its legitimacy through popular participation and electoral process) and socially inclusive (pursues social policies that provide equitable entitlements for all citizens to ensure that their capacities and functionings are adequate for a decent inclusion in societal affairs). The project includes several thematic and region-centred comparative projects (click Social Policy in a Development Context link, under Related Information on the right). This thematic project, Commercialization of Health Care: Global and Local Dynamics and Policy Responses, explores the scope for inclusive health policy in the context of commercialization and globalization. The research for this project is jointly co-ordinated by Maureen Mackintosh and Meri Koivusalo (click Research Team, on the right).
The project focuses on health care, first, because health care systems currently act, in many parts of the world, as powerful drivers of impoverishment and exclusion. Conversely, they have been historically, and can still be, a key arena for redistribution and social inclusion. The scope and capacity for inclusive public action in health care is therefore a core issue for inclusive developmental social policy. Second, the scope and capacity for public action is itself shaped by the patterns of ownership and behaviour in health care systems. Commercialization of health care provision and finance generates incentives and rewards that are known to be inefficient and inequitable, unless heavily constrained by public action. Therefore, third, current international policy and market pressures for trade and investment liberalization in health services—framed in policy debate as "globalization" in health care—and their potential consequences have become the subject of international concern.
The project brings together economists and health policy specialists, largely from Asia, Africa, Latin America and the European transition countries. The project objectives are:
- to contribute, through original collaborative research, to international research and debate on feasible policy for inclusive health care in contexts of commercializing provision;
- to base this collaboration in the needs and perspectives of researchers in low and middle income countries, including "Southern" perspectives on international/global policy issues;
- through collaboration between health care and health policy researchers and microeconomists, to develop a health-systems-based approach to policy analysis, as a challenge to currently dominant policy perspectives.
This project understands "commercialized" health care as the provision of health care services through the market to those able to pay, the associated production of those services for cash income or profit, and payment systems focused on individual payment or private insurance.
Papers commissioned under the project were presented at a conference in Helsinki, Finland, in March 2004, and an edited book is in preparation. The chapters address the following topics:
- health systems and commercialization
- globalization in health care: strategies of multinational corporations
- transnationalization and commercialization in middle income health care
- commercialization and its consequences at very low incomes
- commercialization of the public sector
- global regulation and its implications in pharmaceuticals and medical technology
- universalizing health care access under commercialization
- public-private interactions and equity objectives at low incomes
In addition to the edited volume, United Nations Research Institute for Social Development (UNRISD) Programme Papers, and academic and more popular forms of publication are planned; a number of the conference papers will be posted shortly on this site.
The project’s intellectual ambition is to contribute to a shift in the shared understanding of health care policy towards a framework of analysis and evaluation that prioritizes, and can sustain, universal access to decent health care at all levels of income.