Laurell A C, Arellano O L
Int J Health Serv. 1996;26(1):1-18. doi: 10.2190/PBX9-N89E-4QFE-046V.
Investing in Health is the World Bank's blueprint for a new health policy within the context of structural adjustment. While this document includes a broad range of arguments, its implicit premises are neoliberal as can be deduced from its "agenda for action." Health is defined as a private responsibility and health care as a private good. This leads to a health policy based on two complementary principles: the reduction of state intervention and public responsibility, and the promotion of diversity and competition (i.e., privatization). Thus, public institutions should provide only a limited number of public goods and narrowly defined, cost-efficient forms of relief for the poor. All other health-related activities are considered private duties, to be resolved by the market, NGOs, or families. The World Bank policy provides a pragmatic contribution to efforts to achieve fiscal balance. However, it also pushes to recommodify health care and to turn health into a terrain for capital accumulation through the selective privatization of health-related financial and "discretionary" services. The proposal implies large-scale experimentation and dismantling of public institutions which are the only alternative now accessible to the majority. It rejects health as a human need and a social right, and violates basic values by claiming that life and death decisions can be justly made by the market or through a cost-effectiveness formula.
《投资健康》是世界银行在结构调整背景下制定的新卫生政策蓝图。虽然这份文件包含了广泛的论点，但其隐含的前提是新自由主义的，这可以从其“行动议程”中推断出来。健康被定义为个人责任，医疗保健被视为私人商品。这导致了一项基于两个互补原则的卫生政策：减少国家干预和公共责任，以及促进多样性和竞争（即私有化）。因此，公共机构应仅提供有限数量的公共产品，并为穷人提供狭义定义的、具有成本效益的救济形式。所有其他与健康相关的活动都被视为私人职责，由市场、非政府组织或家庭来解决。世界银行的政策为实现财政平衡的努力做出了务实贡献。然而，它也推动医疗保健重新商品化，并通过对与健康相关的金融和“酌处性”服务进行选择性私有化，将健康变成资本积累的领域。该提议意味着大规模试验和拆解公共机构，而公共机构是目前大多数人唯一可获得的选择。它拒绝将健康视为一种人类需求和社会权利，并通过声称生死决策可以由市场公正做出或通过成本效益公式做出，从而违背了基本价值观。
