文章基本信息

标题：Disintegrated care: the Achilles heel of international health policies in low and middle-income countries
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作者：Jean-Pierre Unger ; Pierre de Paepe ; Patricia Ghilbert 等
期刊名称：International Journal of Integrated Care
电子版ISSN：1568-4156
出版年度：2006
卷号：6
期号：3
DOI：10.5334/ijic.156
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Purpose: To review the evidence basis of international aid and health policy.

Context of case: Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries.

Data sources: National policies, international programmes and pilot experiments are examined in both scientific and grey literature.

Conclusions and discussion: We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control.

Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored.

We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.