Int J Health Serv
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Health sector reform was implemented in many Latin American countries in the 1980s and 1990s, leading to reduced public expenditure on health, limitations on public provision for disease control, and a minimum package of services, with concomitant growth of the private sector. At first sight, Ecuador appeared to follow a different pattern: no formal reform was implemented, despite many plans to reform the Ministry of Health and social health insurance. The authors conducted an in-depth review and analysis of published and gray literature on the Ecuadorian health sector from 1990 onward. ⋯ The leftist Correa government has prepared an excellent long-term plan to unite services of the Ministry of Health and social security, but implementation is extremely slow. In conclusion, the health sector in Ecuador suffered a "silent" neoliberal reform. President Correa's progressive government intends to reverse this, increasing public budgets for health, but hesitates to introduce needed radical changes.
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Harmonizing standards on drug regulation makes sense, but it must protect safety, ensure that only drugs that are truly effective are marketed, and protect a country's ability to act independently. The main driving force behind international harmonization is the International Conference on Harmonization (ICH). When it comes to safety, the ICH has been harmonizing to the lowest common denominator. ⋯ When it comes to transparency, Health Canada has chosen to adopt the more restrictive European Union model rather than the more open process used by the United States. Finally, there are a number of areas in which Health Canada has chosen not to harmonize, and in each case the decision is in the direction of lower safety standards. Harmonization could be of benefit to Canada, but the evidence to date suggests that Health Canada been harmonizing down rather than up.
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The Conservative-led government in the United Kingdom is embarking on massive changes to the National Health Service in England. These changes will create a competitive market in both purchasing and provision. Although the opposition Labour Party has stated its intention to repeal the legislation when it regains power, this may be difficult because of provisions of competition law derived from international treaties. Yet there is an alternative, illustrated by the decision of the devolved Scottish government to reject competitive markets in health care.
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India's ruling class, in association with international agencies, bureaucrats, and business interests, has formed a powerful syndicate that has been imposing its will on the country to the detriment of public health. After gaining independence, India developed a body of knowledge suited to its social, cultural, economic, and epidemiological conditions. This led to an alternative approach to public health education, practice, and research that foreshadowed the Alma Ata Declaration on Primary Health Care of 1978. ⋯ As a result, public health practice in India virtually disappeared. Responding to growing restiveness among a population in need, political leaders have launched the foredoomed National Rural Health Mission and pursued an American brand of public health through the Public Health Foundation of India. Reconstructing the damaged public health system will require pressure on the syndicate to ensure India's public health heritage will be used to effectively transfer "People's health in people's hands" according to the guidelines set down at Alma Ata.
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David Cameron's Conservative-led coalition government is pressing ahead with a highly controversial bill to "reform" the National Health Service (NHS), abolishing existing management structures, opening up provider services to private competition from "any qualified provider", and establishing a competitive market system in place of planning. The proposals fragment the structures and run counter to the founding principles of the NHS, which in 1948 transcended the limitations of markets, delivering health care on the basis of maximum risk sharing and universal access to services, free at the point of use. Evidence shows markets are a costly and inadequate mechanism to deliver universal and comprehensive health care, and private providers will only bid for services where profits are guaranteed. Opposition to the proposals is strong among health professionals and informed opinion, and the bill has divided the coalition parties--but time is running out for those who reject the bill to mount a sustained and concerted resistance.