Int J Health Serv
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Once again the National Health Service (NHS) in England is undergoing major reform, following the election of a new coalition government keen to reduce the role of the state and cut back on big government. The NHS has been undergoing continuous reform since the 1980s. Yet, despite the significant transaction costs incurred, there is no evidence that the claimed benefits have been achieved. ⋯ Indeed, under Labour, the NHS was subjected to further market-style changes that have paved the way for the latest round of reform. The article considers the appeal of big bang reform, questions its purpose and value, and critically appraises the nature and extent of the proposed changes in this latest round of reform. It warns that the NHS in its current form may not survive the changes, as they open the way to privatization and a weakening of its public service ethos.
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Growing evidence suggests that experiences of financial strain and over-indebtedness can contribute to problems of physical and mental health. This article contends that there is a need to carefully examine recent neoliberally informed symbolic and material transformations in the practices and experiences of employment, welfare, and subjectivity in order to provide an appropriately sophisticated analysis of experiences of debt and mental health. ⋯ The variable and multifunctional nature of personal debt has provided a substrate for neoliberal public policy by systematically reinforcing the development of a low-wage labor market and by representing a means through which to transfer collective risk into private responsibility. This article suggests that traditional ways of knowing and acting upon the mental and physical health difficulties associated with problems of debt and material deprivation fail to adequately acknowledge the political and economic role of personal debt growth.
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Several recent papers find evidence that global health aid is being diverted to reserves, education, military, or other sectors, and is displacing government spending. This is suggested to occur because ministers of finance have competing, possibly corrupt, priorities and deprive the health sector of resources. Studies have found that development assistance for health routed to governments has a negative impact on health spending and that similar assistance routed to private nongovernmental organizations has a positive impact. ⋯ However, evaluating IMF-borrowing versus non-IMF-borrowing countries reveals that non-borrowers add about $0.45 whereas borrowers add less than $0.01 to the health system. On average, health system spending grew at about half the speed when countries were exposed to the IMF than when they were not. It is important to take account of the political economy of global health finance when interpreting data on financial flows.