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
Open Access
- 1 September 2005
- journal article
- Published by Wiley in Sociology of Health & Illness
- Vol. 27 (6) , 701-721
- https://doi.org/10.1111/j.1467-9566.2005.00470.x
Abstract
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.Keywords
This publication has 31 references indexed in Scilit:
- Motivation and values of hospital consultants in south-east England who work in the national health service and do private practiceSocial Science & Medicine, 2004
- Place, Space and Reputation: The Changing Role of Harley Street in English Health CareSocial Theory & Health, 2004
- Doing business in the NHS: exploring dentists’ decisions to practise in the public and private sectorsSociology of Health & Illness, 2000
- Are market-oriented health insurance reforms possible in Latin America?Health Policy, 1999
- Cesarean Delivery Rates in ChileBirth, 1998
- Which policy for caesarian sections in Brazil? An analysis of trends and consequencesHealth Policy and Planning, 1993
- Trouble in store: some thoughts on the management of waiting listsSociology of Health & Illness, 1991
- Specialization Among Obstetrician/Gynecologists: Another Dimension of Physician SupplyMedical Care, 1991
- The malpractice crisis and the doctor‐patient relationshipSociology of Health & Illness, 1989
- Professional uncertainty and the problem of supplier-induced demandSocial Science & Medicine, 1982