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Log In Sign Up. Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile.
A case study from Chile Elena S. The aim of this article is to discuss how neoliberal policies implemented in the Chilean Received 23 November health system during the Pinochet regime have a lingering effect on equal access to health Received in revised form 23 February care today. Health has changed from being Keywords: Introduction aims, targets, and mechanisms that aim at satisfying the goals of a free-market system. Health care 2584 considered as one of the main pillars of The aim of this article chioe to discuss the material effects social policy, together with education and social welfare of neoliberalism on health care, using Chile as a case study, .
There is a wealth of tion of programmes and initiatives aimed at ensuring the analyses e. Ayo  on the link between neoliberalism well-being of the population, and especially of some groups and the creation of layers of exclusion and disadvan- that might be marginalised, including children, the elderly, tage through an increasing emphasis on health as choice, the poor, aboriginals, and women .
Neoliberal health that is, a matter of personal responsibility. We argue that care reforms — that are often presented as restructuring of neoliberalism — with its focus on free-markets, individual- ineffective and costly health care systems — imply different ism, liberalisation, and deregulation — does not include in its agenda the welfare of people, communities, and soci- eties.
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Furthermore, other E-mail addresses: Rotaroueffects of neoliberalism, such as the informalisation of the sakellarioud cardiff. Neoliber- population who are in precarious employment. While the neoliberal lic sector. While Key- income inequality, unequal educational opportunities, and nesian economics provided the standard economic model inequitable health care access [51,61].
At this point, neoliberal ideology access and dehumanisation of health care. By the s, communist governments had fallen. We Countries that had previously relied on state interventions then focus on Chile and describe the introduction of neolib- and welfare provision limited their interventionist role; eral policies in health care in the country, and outline instead, they proceeded to lifting capital controls, massive the current situation, before presenting the concluding and unregulated privatisation of state enterprises, and lim- remarks.
Private institutions are deemed economy. In ering social services, including health and education. This term also fails to underline ated economic growth .
The an instrument for reinvigorating capitalist growth. Such negative aims at: Neoliberal labour policies have often worsened ple to participate in decisions that affect their health and working conditions through reduction of job guarantees, health system , neoliberalism does not share the same union protection and other labour rights . Neoliberalism and its impact on the health go exactly in the opposite direction.
Neoliberal policies in Chile Before the mids, the concepts used for the reor- ganisation of health systems envisioned health as a public Bysocial development in Chile — including level good and responsibility of states, in agreement with the of education, national health system, school meals pro- concepts of Keynesian welfarism.
The cile adjustment plans chipe to and better education opportunities and housing plans, all the health sector, as an area that needed restructuring. The growing number of international President Salvador Allende. Harberger, to the loss of the notion that health was a universal right. The result ing increased poverty, unemployment, and deterioration was an increase in economic growth and improvement in in income distribution.
In poverty and extreme poverty dropped from Other studies have also underlined the highly upper-income sectors and various business interests, while unequal access to good quality health care [45,48] and a tough position was maintained against labour organisa- education . One of the main reasons behind this per- tions. Consequently, the economic policies adopted led to a sisting high inequality is that key sectors of the economy — further deterioration in income distribution and increased such as banking, manufacturing, retail trade, private pen- poverty .
These measures, how- ever, did not include any investments in human capital or 5. The construction of a neoliberal health system in the result of rigidities in the social structure and market Chile distortions. As a result, for the entire population. This cgile to be accomplished many Chileans lye these programmes as an attempt through suspending the gratuity of services, and abandon- to dismantle the social security system, which had been ing the concept of the socialist welfare state by turning substantially expanded during cbile governments of Eduardo Chile into a free market state .
Decentralisation was Frei — and Salvador Allende — .
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The two major milestones of privati- The democratic governments that succeeded the dic- sation were the creation of Pension Fund Administrators tatorship sought to reverse the regressive trends in the AFPs, from their initials in Spanish in and private Chilean society.
After the end of the Pinochet regime in health insurance institutions ISAPREs, from their initialsthe following governments continued largely with in Spanish in Between andthe goal of leg the role of the state in the health system was partly accomplished: Public spending on health as a a series of problems regarding chlle health services, total of GDP also increased from 1.
Working conditions and salaries had deteriorated, as a result of the deregulation and market liberalisation, leading to an increased informalisation of labour, intro- 5. The informalisation of and are similar to those of highly industrialised countries the labour market has also had a disproportionate impact . Health indicators for . This decrease was due to improved performance of FONASA, unemployment caused by the s Asian crisis, and the rising costs of private health plans .
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Indeed, while the pri- age, and risk, a fact that often excludes women of repro- vatisation of more health care services requires a greater ductive age, the elderly or chilw young, creating a structural vigilance of the private sector from the part of the gov- disadvantage for these parts of the population.
Inonly 2. Adult women of reproductive age may our case, abuses by the ISAPREs and the multinational com- pay up to four times more than men, and the proportion of panies that own them.
This may be linked to the fact that only 3.
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Concluding remarks such as Spain and the United Kingdom ; by contrast, the FONASA expenditure is as low as that of the aver- Neoliberalism focuses on the notions of privatisation, age for Latin American countries . This is due to the liberalisation, deregulation, and minimal state interference fact 220584 ISAPREs, due to ex-ante for example, cream- in the economy.
In the neoliberal discourse, people become skimming and ex-post for instance, adjustment for sex, consumers. Recent studies have found that from, and be able to pay for it.
As Manderson and Warren  have demonstrated, inequity for specialised, dental, general practitioners and this discourse is often acontextual, treating people as physician visits. This access to health care in Chile has become more equi- is problematic for a variety of reasons. First, the presence table and responsive to the needs of the patients; they of income inequality — which, in the case of Chile, is very do underline, however, that equity issues still remain high — forms a structural disadvantage, which can lead regarding quality of care, barriers to health system, and to reduced economic and social capital, often resulting in differential access for health problems lley are not cov- further ill health.
A human-rights approach to various health indicators such as infant and mater- health stands in contrast to the discourse of responsibil- nal mortality have also improved.
This has been let isation and marketisation offered by neoliberalism, since outcome of better living conditions resulting from socioe- it seeks to address inequalities and discriminatory prac- conomic development, maternal and child protection tices that result in inequitable health outcomes.
This is programmes carried out by the public sector, and strong particularly relevant in the current context of efforts to policies in preventive care [43,61]. Social protection in vices see for example Economou et al.
Development and Change ;39 5: Economic growth in Chile: While Chile has made important steps towards achiev- Available chle It is, therefore, imperative that [Accessed 22 February ].
Hall P, Lamont M, editors. Social resilience in the neoliberal era. Cambridge University and identifying critical challenges, while at the same time, Press; Achieving effective universal of equitable, timely, and good-quality health care services. Health Policy and Planning ;29 6: Economic reforms in Chile: The University of Michigan Press; Free markets and the generals.
Newsweek January Elena S. Fondecyt, Postdoctorate Programme project number  Gideon J. A gendered analysis of labour market informalization and Global Social Policy ;7 1: Women, public policy and the state. References  Harvey D. A brief history of neoliberalism. Oxford University Press; Why neoliberal reforms have failed in Latin  Annick M. The Chilean health system: Health and social security Factory.
Managed care in Latin America: Understanding health promotion in a neoliberal climate tionalisation of the health sector in a context of reform. Cadernos de and the making of health conscious citizens. El caso  Barrientos A. Health policy in Chile: Bulletin of Latin American Research ;21 3: Docu-  Barro R. One Pinochet legacy that deserves to live. Business Week mento de trabajo, No. Universidad de Chile; Health care reform in Chile.