The Privatization Of Care

Nursing homes are where some of the most vulnerable live and work. In too many homes, the conditions of work make it difficult to make care as good as it can be. For the last eight years an international team from Germany, Sweden, Norway, the UK, the US and Canada have been searching for promising practices that treat residents, families and staff with dignity and respect in ways that can also bring joy. While we did find ideas worth sharing, we also saw a disturbing trend toward privatization. Privatization is the process of moving away not only from public delivery and public payment for health services but also from a commitment to shared responsibility, democratic decision-making, and the idea that the public sector operates according to a logic of service to all. This book documents moves toward privatization in the six countries and their consequences for families, staff, residents, and, eventually, us all. None of the countries has escaped pressure from powerful forces in and outside government pushing for privatization in all its forms. However, the wide variations in the extent and nature of privatization indicate privatization is not inevitable and our research shows there are alternatives.

The surge of privatization in Canada threatens the social security network that has been carefully built over the years. People are asking, "What will this mean for 'human' services in the future? Will the same service be forthcoming under privatized health care as that to which we have become accustomed under a publicly owned system?" These are some of the questions that Vera Ingrid Tarman examines in this timely new book. After carefully laying out the boundaries and the theoretical issues surrounding the private versus public debate, she then uses nursing homes in Ontario as a case study to illustrate the impact of privatization. A careful reading of this book will help us to understand what some of our most cherished institutions will look like under a profit oriented private system.

Universal, comprehensive health care, equally available to all and disconnected from income and the ability to pay, was the goal of the founders of the National Health Service. This book, by one of the NHS's most eloquent and passionate defenders, tells the story of how that ideal has been progressively eroded, and how the clock is being turned back to pre-NHS days, when health care was a commodity, fully available only to those with money. How this has come about-to the point where even the shrinking core of free NHS hospital services is being handed over to private providers at the taxpayers' expense-is still not widely understood, hidden behind slogans like "care in the community," "diversity" and "local ownership." Allyson Pollock demystifies these terms, and in doing so presents a clear and powerful analysis of the transition from a comprehensive and universal service to New Labour's "mixed economy of health care," in which hospitals with foundation status, loosely supervised by an independent regulator, will be run on largely market principles. The NHS remains popular, Pollock argues, precisely because it created the "freedom from fear" that its founders promised, and because its integrated, non-commercial character meant low costs and good medical practice. Restoring these values in today's health service has become an urgent necessity, and this book will be a key resource for everyone wishing to to bring this about.

This book begins with the international context for health care reform and then moves from coast to coast, setting out what is known about the reforms in health care privatization that are underway and about their impact on women.

Introduction -- Key trade treaty rules and health safeguards -- Examing recent reports on health care reform -- Hazardous mixture : trade treaties and helath care reform proposals -- Towards healthy health care reform.

In Unmanageable Care, anthropologist Jessica M. Mulligan goes to work at an HMO and records what it’s really like to manage care. Set at a health insurance company dubbed Acme, this book chronicles how the privatization of the health care system in Puerto Rico transformed the experience of accessing and providing care on the island. Through interviews and participant observation, the book explores the everyday contexts in which market reforms were enacted. It follows privatization into the compliance department of a managed care organization, through the visits of federal auditors to a health plan, and into the homes of health plan members who recount their experiences navigating the new managed care system. In the 1990s and early 2000s, policymakers in Puerto Rico sold off most of the island’s public health facilities and enrolled the poor, elderly and disabled into for-profit managed care plans. These reforms were supposed to promote efficiency, cost-effectiveness, and high quality care. Despite the optimistic promises of market-based reforms, the system became more expensive, not more efficient; patients rarely behaved as the expected health-maximizing information processing consumers; and care became more chaotic and difficult to access. Citizens continued to look to the state to provide health services for the poor, disabled, and elderly. This book argues that pro-market reforms failed to deliver on many of their promises.The health care system in Puerto Rico was dramatically transformed, just not according to plan.

How can we plan, organize, distribute, and offer care in ways that treat both those who need it and those who provide it with dignity and respect? Using the example of residential services, Troubling Care: Critical Perspectives on Research and Practices investigates the fractures in our care systems and challenges how caring work is understood in social policy, in academic theory, and among health care providers. In this era defined by government cutbacks and a narrowing sense of collective responsibility, long-term residential care for the elderly and disabled is being undervalued and undermined. A result of a seven-year interdisciplinary research project-in-progress, this book draws together the work of fourteen leading health researchers, including sociologists, medical practitioners, social workers, policy researchers, cultural theorists, and historians. Using a feminist political economy lens, these scholars explore and challenge the theories, work organization, practices, and state-society relations that have come to shape long-term care. Troubling Care offers critical perspectives on the often disquieting arena of care provision and proposes alternatives for thinking about and meeting the needs of some of our most vulnerable citizens in ways that go beyond residential care. This book seeks to bridge not only the gaps between disciplines, but also those between theory and practice. Features: takes an interdisciplinary approach, making this work appropriate for courses in a variety of disciplines including sociology, medicine, social work, health policy, cultural studies, and political economy includes the work of fourteen leading health researchers, including sociologists, medical practitioners, social workers, policy researchers, cultural theorists, and historians bridges the gap between theory and practice by incorporating both theoretical research and specific case examples