Privatization and trade in health services: a review of the evidence.

Health care provision, like other areas of welfare, has increasingly been subject to processes of privatization and contracting out, leading in some cases to an increased involvement of for-profit corporations. Such processes are likely to interact with processes of liberalization at the international level in ways that we would expect to lead to a growth in the international trading of such services. However, health service provision is usually deeply embedded in state structures at the national level, and the form of such structures varies greatly. The degree and type of private involvement allowed for or facilitated by national-level systems defines the scope for the potential development of international trade in health services. The author reviews existing sources of data on the levels of private provision across advanced capitalist countries, countries in transition from Soviet-type systems, and developing countries, and highlights processes of change that are likely to increase such provision. Private provision is growing slowly but steadily in most countries. While levels of international trade in health services are difficult to ascertain, the interaction between national processes of reform and international processes of liberalization is likely to increase such trade.