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.
content with the U.S. stock performances, the companies are now seeking a wider
market base, and are invading Latin America.
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.
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.
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
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.
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.
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
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.
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."
Guellec, Journalist medical specialty Member,
Foreign Press Association
tel (914) 271 5644
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