Marketizing HMOs to Latin America
The number of for-profit health care organizations has quadrupled in the pas 17 years, a study by the Henry J. Kaiser Family Foundation said. For-profit HMO's were 18% of all plans in 1981 but increased to 74% by 1998. The proportion of enrollees in for profit HMO's grew from 12% to 63% during that period.
Not content with the U.S. stock performances, the companies are now seeking a wider market base, and are invading Latin America.
The major research study into this phenomenon appeared in the New England Journal of Medicine on April 8th, 1999 and was virtually ignored by the media. There were a few articles here and there. Such familiar names as Aetna, Cigna and others have entered Argentina, Brazil, Chile, and Ecuador (the 4 countries studied in depth by the research team) and opened newly privatized markets. The group is based at the University of New Mexico and reports that many of the managed care organizations operating procedures most frequently criticized and under review in the U. S. are quietly being exported.
Principal investigators for this New England Journal of Medicine study are: Howard Waitzkin M.D. Ph.D. Professor and Director of the Division of Community Medicine in the University of New Mexico School of Medicine Department of Family and Community Medicine and Celia Iriat Professor of Collective Health at the University of Buenos Aires and visiting faculty member at UNM. Karen Stocker, a graduate student in Anthropology shares authorship. The group focused mainly on these 4 countries in addition to the United States.
Since 1993, according to Dr. Waitzkin, institutions such as the World Bank and the International Monetary Fund have made privatization of state owned hospitals and clinics a lending requirement when Third World countries are seeking loans. Often times those former state run hospitals and clinics are purchased by US and European insurance companies, who then introduce US style models of managed care.
The history of health care in many Latin American countries is vastly different from the systems in the United States. Despite economic underdevelopment, in Latin America there is an aim to assure universal access to health care. However during the 1990's the World Bank and other international lending agencies instituted "structural adjustment" requirements that public health care institutions and government social security funds be converted to private management and/or ownership as conditions for new loans. These privatization programs have created multi-billion dollar capital pools that multinationals have sought to capture.
All this creates barriers to health care for the elderly, the unemployed, and the working poor. Governments in Latin America traditionally have accepted the social responsibility of providing basic care for their people, but as managed care has moved in the priorities have shifted and spending is now reduced for these vulnerable groups of patients. Spending for clinical services is down too due to administrative needs and mainly the return for investors.
Countries that fail to implement "structural adjustment," read managed care/shareholder bottom line policies, are threatened with the cutoff or "drastic reduction of loans, credit to buy essential imports, and food aid."
As the expansion of managed care slows in the U.S. managed care organizations are likely to continue to enter new markets abroad. Here is a comment from someone in Thailand: "I am working in a big government hospital in Thailand. As you know, my country is developing in all aspects and try to copy some managing system from yours. My hospital is for serving the under privileged people, that is over 90% of patients cannot pay even a baht (1/37 US $) and sometimes the hospital must pay for return home bus-fare. When IMF came in 2 years ago it said this system cost a lot of money and cause lots of missed management. So it suggests change by turning the hospital to autonomous hospital and use something like HMO system to manage the ill people. I wonder it will be disaster to Thai people". I want to protect the writer's identity.
Dr. Waitzkin has said that "it is a common perception that health care is better in the United States, yet in many instances it hasn't been. People migrate to the U.S. for a number of economic reasons, but finding better health care is seldom one of them."
Dorothy Guellec, Journalist medical specialty Member,
Foreign Press Association
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