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The promotion of private health insurance and its implications for the social organisation of healthcare: a case study of private sector obstetric practice in Chile
Author(s) -
Murray Susan F.,
Elston Mary Ann
Publication year - 2005
Publication title -
sociology of health and illness
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.146
H-Index - 97
eISSN - 1467-9566
pISSN - 0141-9889
DOI - 10.1111/j.1467-9566.2005.00470.x
Subject(s) - health care , private sector , business , promotion (chess) , government (linguistics) , position (finance) , politics , work (physics) , public relations , caesarean section , nursing , economic growth , medicine , political science , pregnancy , finance , economics , mechanical engineering , linguistics , philosophy , engineering , biology , law , genetics
This paper examines some of the implications of the process of privatisation of a national healthcare system for the delivery, organisation and, ultimately, the outcome of services. Through a case study of obstetric care in Chile, we illuminate the relationships between the macro‐level of political decisions, the meso‐level of the organisations through which government reforms were enacted, and the micro‐level of clinical practice. We show that, for a significant proportion of Chilean women seeking maternity care, privatisation has led to expanded access and to ostensibly highly‐personalised relationships with specialists. However, because of the fragmentation of maternity services, the altered work patterns for obstetricians occasioned by changes in healthcare financing and the relatively weak market position of most obstetricians, this personalised care is dependent on highly technologised obstetric practices. By examining the specific organisational arrangements under which private maternity care is conducted in Chile we shed light on the connection between privately‐funded maternity care and high caesarean section rates in this setting.