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Summary This article addresses the escalating privatization of health-care services in Kerala, an Indian state. While Kerala's public health-care system has been consistently lauded for its commendable strategy of providing high-quality and affordable health care, recent developments have seen the emergence of large commercial multispecialty hospitals and the integration of private insurance into the public health sector, transforming health care into a profitable industry. This situation underscores the significance of equity, accessibility, and affordability in the health-care sector. Substantial government intervention becomes imperative to curb the increasing involvement of private entities in health-care services.

In 1993, the Colombian government sought to reform its health care system under the guidance of international financial institutions (the World Bank and International Monetary Fund). These institutions maintain that individual private health insurance systems are more appropriate than previously established national public health structures for overcoming inequities in health care in developing countries. The reforms carried out following international financial institution guidelines are known as \"neoliberal reforms.\" This qualitative study explores consumer health choices and associated factors, based on interviews with citizens living in Medellin, Colombia, in 2005-2006. The results show that most study participants belonging to low-income and middle-income strata, even with medical expense subsidies, faced significant barriers to accessing health care. Only upper-income participants reported a selection of different options without barriers, such as complementary and alternative medicines, along with private Western biomedicine. This study is unique in that the informal health system is linked to overall neoliberal policy change.

This paper explores the public health system's differential construction of Mexican and Cuban immigrants' \"deservingness\" of citizenship benefits and its preparation of them for different roles in U.S. society. Civic institutions such as the public health care system are charged with inculcating normative behavior in immigrants and instilling in them different conceptions about their rights and responsibilities. Faced with limited resources under the implementation of Medicaid managed care, hospital administrators created new categories of \"deserving\" and \"undeserving\" immigrants based on neoliberal standards of individual responsibility and self-discipline. As a result, hospital policies construct different types of \"cultural citizenship\" for Cuban and Mexican immigrants, preparing the former to be active citizens and discouraging the latter from pressing demands on American civil institutions. I show that this negative construction of Mexican immigrants' moral worth leads to unmet health needs and poor health outcomes.

After the 1997 economic crisis, the South Korean government implemented neoliberal policies in many sectors. In health care, the government attempted to privatize nine public hospitals, framing the initiative as \"better management.\" In this discourse, public hospital workers were stereotyped as lazy and incompetent, while public hospitals were portrayed as poorly managed and of low quality. However, the government did not present any relevant evidence of improvement in already privatized hospitals, even though three hospitals had been semi-privatized at that time. In this study, the authors evaluated the effects of the semi-privatization, comparing the performance of the semi-privatized hospitals with that of the nine other hospitals targeted for privatization. The study found adverse effects on performance, unlike the claims made by the government. Semi-privatization intensified the workloads of hospital workers and the instability of employment, froze or decreased real wages, and drastically increased hospital revenue per patient stay. The changes may have resulted from redefining profit as the goal of the hospitals, as opposed to the previous focus on decision-making on public health. These research findings played a decisive role in the struggle to keep the targeted public hospitals free of privatization, especially in two of the nine hospitals targeted for privatization in 2001.

In this article we examine the impact of Medicaid managed care on safety net organizations in New Mexico and their ability to maintain their traditional mission of charity care. We address two particular areas of concern that have arisen in the literature on Medicaid managed care. First, analysts have debated under what circumstances safety net organizations are better positioned to survive under market competition without abandoning their social orientation. Second, analysts have suggested that populations in rural areas may be more disadvantaged under Medicaid managed care due to its intensification of already-existent barriers to access. By comparing the differential ability of safety net organizations in rural and urban New Mexico to buffer their patients from potentially harmful effects of Medicaid managed care, we identify factors that place these safety nets particularly at risk. We find that a rural location, lack of affiliation with a larger organization, and lack of recourse to charitable funding are \"risk factors\" determining who sinks - and who floats - in this new competitive health care system.

Neoliberalism has been the defining paradigm in global health since the latter part of the twentieth century. What started as an untested and unproven theory that the creation of unfettered markets would give rise to political democracy led to policies that promoted the belief that private markets were the optimal agents for the distribution of social goods, including health care. A vivid illustration of the infiltration of neoliberal ideology into the design and implementation of development programs, this case study, set in post-Soviet Tajikistan's remote eastern province of Badakhshan, draws on extensive ethnographic and historical material to examine a \"revolving drug fund\" program—used by numerous nongovernmental organizations globally to address shortages of high-quality pharmaceuticals in poor communities. Provocative, rigorous, and accessible, Blind Spot offers a cautionary tale about the forces driving decision making in health and development policy today, illustrating how the privatization of health care can have catastrophic outcomes for some of the world's most vulnerable populations.

This study builds on an analytical framework of access to healthcare and, using notes from interviews conducted with 110 migrants of different categories, it discusses the fit between migrant patients and Turkish health services. There is an overall mediocre fit between migrant patients and the Turkish healthcare system, which varies for different migrant groups, and is influenced by the dimensions of awareness, availability, affordability, and accommodation. Migrants’ social capital and socio-economic statuses affect the degree of fit, while irregularities in their legal statuses do not necessarily create a misfit. The existence of many private healthcare institutions offering various services to patients with different incomes and operating in informal ways has improved accessibility, availability, affordability, and accommodation and thus affects the fit positively. Therefore, the health reforms that paved the way for privatization, marketization, and commodification of health services in Turkey in the early 2000s also help explain the degree of fit. Migrants suffer most from language barriers in the health system, and there is an alarming decline in acceptability especially for Syrian refugees, who have reported facing discrimination while seeking healthcare.

The application of mobile health holds promises of achieving greater accessibility in the evolving health care sector. The active engagement of private actors drives its growth, while the challenges that exist between health care privatization and equitable access are a concern. This article selects the private internet hospital in China as a case study. It indicates that a market-oriented regulatory mechanism of private mobile health will contribute little to improving health equity from the perspectives of egalitarians and libertarians. By integrating the capability approach and the right to health, it is claimed that mobile health is a means of accessing health care for everyone, where substantive accessibility should be emphasized. With this view, this article provides policy recommendations that reinforce private sector engagement for mobile health, recognizing liberty, equity, and collective responsibility in the Chinese context.

Sri Lanka reports impressive health indicators compared to its peers in the South Asian region. Maternal and infant mortality are relatively low, and several intractable communicable diseases have been eliminated. The publicly financed and delivered “free” healthcare system has been critical to these health achievements. Placing the country’s healthcare system in historical context, this commentary analyses the contradictions and political tensions surrounding Sri Lanka’s 2018 Universal Health Coverage (UHC) policy, with attention to the Ministry of Health’s plans for public–private partnerships (PPP). As economic exigencies and private interests increasingly erode the 1951 “Free Health” policy, this commentary calls for a re-envisioning of UHC that can meet people’s aspirations for health and social justice.

Background/Objectives: This study examines the transformation of Turkey’s hospital sector from 2002 to 2022, focusing on physical capacity, service utilization, and workforce distribution in the public and private sectors. Methods: Longitudinal data from the Ministry of Health were analyzed using trend and breakpoint methods to evaluate hospital beds, qualified beds, intensive care beds, service volumes (outpatient visits, inpatient admissions, surgeries, and hospitalization days), and staffing (physicians, nurses, and midwives). Results: Findings reveal a marked shift in the balance between public and private providers. Due to public regulations effectively controlling resource allocation, the private sector’s share expanded to around one-fourth of the system. Private capacity in total beds rose from 7.53% to 21.00%, outpatient visits from 4.58% to 15.07%, and inpatient admissions from 10.10% to 30.63%. Breakpoint analyses indicate crucial turning points around 2005, 2008, and 2011, when policy changes restricted public capacity but facilitated private investment. Although the public sector’s share in total beds declined, its proportion of qualified and intensive care beds, as well as dialysis machines, increased, suggesting a strategic shift toward complex, high-quality services. Conclusions: Over the past 20 years, Turkey’s hospital sector exemplifies privatization without ownership transfer. Although delayed, private hospital expansion aligned with global neoliberal trends. Policy regulations played a key role in both promoting and limiting sector growth. A constant conflict exists between market-driven resource allocation and public health needs, which must be considered in restructuring efforts alongside private sector motivations.