Hunter Benjamin M
School of Social and Political Sciences, University of Glasgow, Glasgow, UK.
School of Global Studies, University of Sussex, Brighton, UK.
Global Health. 2025 Jun 13;21(1):37. doi: 10.1186/s12992-025-01122-7.
Contemporary conditions require detailed study of internationalisation. This article offers a novel perspective on processes of internationalisation in healthcare, adapting an approach from higher education studies and enhancing it with insights from sociological scholarship on moral economies. The article asks how institutions and individuals respond to the globalising healthcare environment, and what this reveals about normative questions that govern healthcare provisioning in national contexts. This is pursued using qualitative data from a study on international commercial services in the English National Health Service (NHS).
The findings of the research demonstrate how the UK government has sought to build political consensus around specific (commodified) forms of internationalisation in a context of fiscal austerity and xenophobia surrounding the provision of public services. The English NHS has been politically re-imagined as world-leading and of interest as an export industry. Study findings show this stance is premised normatively on processes of subsidy between two apparently distinct spheres - from international (private) to national (public) - but that in practice the distinction is hazy and subsidy at times indirect, routed to individual staff members or to commercial teams. The ascendancy of this as a prevailing, politically legitimate form of internationalisation for the English NHS contrasts sharply with non-commodified alternatives decried as 'health tourism'.
The internationalisation framework presented in this article offers a platform for future research that can shed light on the contexts, visions, policies and contestations the emerge as healthcare institutions respond to processes of globalisation. It will be important to avoid uncritical approaches to research and policy by examining not just what forms of internationalisation find favour, and their basis in geographical and racialised hierarchies, but also how approaches to healthcare internationalisation impact inequalities within and between nations.
当代形势需要对国际化进行详细研究。本文提供了一个关于医疗保健国际化进程的全新视角，采用了高等教育研究中的一种方法，并结合了社会学界关于道德经济的见解对其进行深化。本文探讨了机构和个人如何应对医疗保健全球化环境，以及这揭示了在国家背景下管理医疗保健供应的规范性问题。这一探讨是通过对英国国家医疗服务体系（NHS）国际商业服务研究的定性数据来进行的。
研究结果表明，在财政紧缩以及围绕公共服务提供存在仇外心理的背景下，英国政府如何试图围绕特定的（商品化的）国际化形式建立政治共识。英国国家医疗服务体系在政治上被重新塑造为世界领先且作为一个出口产业具有吸引力。研究结果显示，这一立场在规范上基于两个明显不同领域之间的补贴过程——从国际（私人）领域到国家（公共）领域——但实际上这种区分是模糊的，补贴有时是间接的，流向了个体工作人员或商业团队。这种形式作为英国国家医疗服务体系一种普遍的、政治上合法的国际化形式的优势，与被谴责为“医疗旅游”的非商品化替代形式形成了鲜明对比。
本文提出的国际化框架为未来研究提供了一个平台，该研究能够阐明随着医疗机构应对全球化进程而出现的背景、愿景、政策和争议。重要的是要避免对研究和政策采取不加批判的方法，不仅要审视哪些国际化形式受到青睐及其在地理和种族化等级制度中的基础，还要审视医疗保健国际化方法如何影响国家内部和国家之间的不平等。
