Outlook Indian sub-continent and A fter the headlineshare the remaining 10%. outside its Seattle Some of the least developed summit last countries spend as little as $5 •December. per head per year on health World Trade Organisation care, compared with S3.500 (WTO) has become in the USA. In these countries there is expanded power of grasping multina- little short or medium term prospect of substantial profBut few realise the extent its to be made exploiting the to which the WTO is also acca lot ocalla care - with exception of policies of member governThese firms look to WTO ments on health care and regulations to help preserve education.
The WTO's objective is to their rip-off prices and preEvent any Third World coun to the brute forces of the free market, reinforcing the more cheaply.
However the WTO does tion of the "developing" look cagerly towards a numeconomies, and opening up ber of countries - including the world as a free-fire zone Chile. Brazil, for the monopolies. Republic, Hungary and Poland - which are "decenAt scatte this straicky ran into sustained opposition tralising andfor commercialfrom some Third World gov- ising the bealth sector in a ernments as well as cam- bid contain cost prespaigners representing the "may offer interesting busi ronmental issues. BOSS SOCCE But behind the scenes canwhile in M chicontac Third which a new global market World in health and social services OECD, could be opened up had been with running for over a year, and the MR the World Bank and other global organisathe WTO.
A Background Note from tions have concentrated on foisting their dogmatic nosthe WTO Secretariat set out trums of market-led some of the key issues in "reforms" to hold down state 1998. -or spending and ensure the leading lights global future of the private sector Thatcherism there are The WTO document urges caster elements member states to discuss health care spending which HOW DeSE "ongoing reforms in national the developed health systems are mutually economies, with the excepsupportive and theserer releUSA, vans, marker-based." spending is largely govern- Standard market-style ment spending, or financed solutions being shamelessly through compulsory insur- foisted onto Third World ance schemes. For neo-libthis agencies include the privatirepresents an unwelcome sation of some or all of their increase in taxation or over- hospitals to promote "combead costs, restricting com- petition", the privatisation of While they and the imposition of cash TOS OR SUODORE restrict or reduce this "bur- limits and efficiency targets den", the WTO also wants to open up potential new mar- stay in hospital) to squeeze kets - and promote the role down spending in the state of the private sector. This sures and rationalisation. to which the dominant role Governments also AUCERECH spending being urged make a wholesale switch of govern. sector hospitals and services, making it more difficult tor tals to primary health care, international capital to com. which according the pete and build up its stake in World Health Organisation offers health industry. Health care is certainly a low-cost treatment. But there remains a differ. also one of the most starkly ence of opinion between unequal. By the mid 1990s KOD counties over the imposition of new grouped in the OECD, spent for health a total of $2 trillion ($2,000 medicines, especially in the poorest countries. While the This was 90% of total world WHO recoanises charges as an obstacle to access to serthe majority of the world's vices for and population them most Whine ane and openly sceptical about the Latin America, Africa, the reforms, the Bank is a gungBack 1987 the Bank included CUST recovery as part of its agenda for health care in developing argue aggressively in favour of charges - as an "cgalitarthat so-called "cost sharing" or "co-payment" more equitable because they "charge those [the well-to-do who make most use of services ... , channelling subsidies to those least able to pay"!
A key factor has to be the tightening of the financial regime in hospitals to ensure account should be opened immediately on admission. collect a cash deposit early in This means striving to bills before patients leave the premises".
Perhaps Thoro advantageous from the Bank's standimposing user fees for gorernment funded services between private and public providers and lays the basis which can further cut government spending One World Bank pamphlet explains that "Countries cannot jump self-financing health THEO insurance schemes without first passing the hurdle of #posing user acco in gov ernment facilities, especially hospitals. The reason is simply taat wace scopic nave the option of obtaining health services at zero or low cost they are unlikely to have much incentive to pay insurcorch unexpected health hazards."
Indeed if some services are available charge "How can the private sector such circumstances?" The deal combination for strategic model is a combina• tion of high foes for hospital scare people into an affordable" insurance scheme. determined most to Third World services on a market model, even toe lack or money is no objection: "Rural insurance is more ditticult, but hardly impossible. Farm income from cash crops provide to capture funds for health Health poor second to the balance sheet in these plans and calthe market appears almost quaint when it secks to discuss which services - if any - should be subsidised in the public interest: World News "Take the example of vaccinations for polio or tetanus benefits because they rein• force the immune system of contract communicable discases. People should be, and are, willing to pay for such private benefits. Yer vaccinations offer public benefits as well..."
This type of logic does not ing of health professionals grappling with the problems of poverty and disease.
So under its so-called "flag: ship programme" the World Bank has been systematically seeking out top adminembryonic health services in and flying them Washington - the home of the world's most privatised and most disastrously expensive and wasteful health care courses in the value of the market system.
World Bank shrugs aside the abundant evidence that demand for services the poorest countries falls away when charges without any care 21 3ii. Instead its economists argue that the fallis partially offset by improved qual.
For an example of these policies in action, the "reforms" imposed on India as a Structural Adjustment Programmes сус-орепсг The Indian government's around 1 percent of GDP well below the WHO recom thenace and amounted capita in 19t4.5 $2 per But in the midst of this dwindling allocation the Coverine boosted the priority attached to population control. with the lion's share of resources allocated to the rural areas. the allocation of hospital services, with urban areas enjoying times more beds per head of than the rural PU PUEROR areas.
The government abdication from the provision of services has left the private sector maximum scope the countryside: indeed private sector health spending ernment spending as a share of GDP In place of raising the needed services through taxation, the has resorted to World Bank and other international loans charges.
Meanwhile the private sector can get government help to set up clinics, hospitals 70% of newly-qualified doctrained public 4082 proceca to WORk immediately in the booming many of these cave toe country to practise abroad.
This burgeoning of the largely unregulated private sector brings with it many of encountered in the privatised health unnecessary operations, redundant tests, overcharge and over-prescribe. They also carry out the average in government Private hospitals try keep their beds full - - but also refuse to admit patients who cannot pay a cash deposit beforehand charges predictably generates the greatest burden on poorest Moscos. While upper spend around 4 percent of their income on health care, the lower middle classes can spend 8-10%, while surveys have shown on the lowest income spending 14% on health.
The market system isn't delivering affordable accessible bealth i care for the poor Asia, in Africa or in Latin America.
But taere are no grounds for complacency anywhere. The WO debates and the OECD and other initiatives should remind us that mar"Build Operate Transfer (known here as the Private Finance arc already alive and kicking in NHS OUB WHOSE advanced countries. And the debate over user fees, far from being resolved. keeps coming back with cach increase La casual vices.Health workers and those who value comprehen to back the fight against the WTO and its initiatives.
Outlook World News D) Foreign Policy: unfavourable climate which is unlikely to change in the