Textbook Notes (363,264)
Canada (158,281)
HLTC43H3 (19)
Chapter 8

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University of Toronto Scarborough
Health Studies
Joseph Bryant

Chapter 8 hltc03 Introduction • Concerns about rising deficits that begun in the early 80s drove governments to reduce social and health spending • Canadian and UK government looking more to incorporate the private sector in health care What is a market? • A market is a complex set of social institutions that enables the exchange of a commodity such as a good or service between a seller and buyer • The market represents a means by which labour power and capital, income, and wealth are distributed through processes of production and consumption o Inequalities in distribution gives way to political power and influence • The market may represent powerful economic forces that influence public and health policy • Interwoven with markets are politics, ideology, and power • Markets as highly political because politics shapes market activities Characteristics of markets • First, markets are systems of rules and regulations set and enforced by both state and non-state agencies o Regulations govern what can be marketed and where marketing occurs o Control costs, profit margins etc o Companies have considerable power to do this • Second, markets are complex o Any one market is a complex of markets involving different industries and imbedded in different social relations  Transportation, insuracnce etc • Increasing market mechanisms for health care delivery may also affect the distribvution of income and other economic resources o To make the iondtroduction of market approaches more attractive to citizens, governments offer tax cuts that primarily benefit the well-off o The well-off tend to pay more in taxes for health care, but use them less. The creation of markets leads to a transfer of income from the lower-income groups to higher-income groups. The health care system then comes to be financed more out of private resources than general ones. Thoise least able to pay use health services more • Third, market are inherintly unstable o Instability reflects competition o May be a good thing, but also may be bad because basic needs and resources may become inaccessible to some groups • Market success endows greater power in the market itself possibly at the expense of society as a whole The rationale for market competition • Economic theory claims the superiority of markets over government control and regulation of health care o Argument for adopting market approaches to health care services is from economic theory o The beliefs include:  Markets are the source of innovation  Deregulation and privatization of health and social services facilitate innovation  Reduced role for the state in policy areas  Efficiency in cost and operation • Emphasis on market is supported by political ideologies consistent with tenets of neo-liberalism and traditional economic theoryn o Neoliberalism arguments attractive because policy-makers view health services as a potential site for private investment o Turning to private health care agencies to finance and provide health care reduces the cost for the government, but yet turning to private sector leads to creation of health care markets  Health care then becomes a commodity and not a puyblic service Health care markets • Private financing of health care results in creation of health care markets o Government can transfer financing and delivery of health care services to the private sector as repredented by public-private partnerships (P3s) • P3 is an arrangement b/n the public and private sectors to provide a project or service that the public sector has ussually delivered o Spectrum of P3 arrangements  On one end public assets might be privatized or transferred to private sector  Other arrangements may involve contracting out services to private firms  Other arrangements may have private agencies managing public assets o Provincial governments in Ontario, Alberta, and BC have done so to build schools, highways etc • P3s not only lead to creation of health markets, but create a web of other markets and commodities such as those in US that shape how hospitals, doctors, and other health professionals provide care to patients • Box 8.4 • Even though most canada hospitals are private not-for-profit, there are private, not-for-profi
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