Globalisation and commercialisation of healthcare services: with reference to the United States and United Kingdom

The thesis seeks to interrogate historically the relationship between multinational healthcare service companies and states in the pursuit of market-oriented reforms for healthcare. It constitutes a critical reading of the idea of globalisation as a concept with substantive explanatory value to analyse the causal role of multinational service firms in a commercial transformation in national healthcare service sectors. It analyses the development and expansion of commercial (for-profit) healthcare service provision and financing in the healthcare systems of OECD countries. The hospital and health insurance sectors in the US and UK are analysed as case studies towards developing this critical reading from a more specific national setting. The thesis contributes to developing a framework for analysing the emergence of an international market for trade in healthcare services, which is a recently emerging area of research in the social sciences. As such, it uses an interdisciplinary approach, utilising insights from health policy and international political economy. The research entails a longitudinal study of secondary and primary sources of qualitative data broadly covering the period 1975-2005. I have also made extensive use of quantitative data to illustrate key economic trends that are relevant to the changes in the particular healthcare services sectors analysed. The research finds a substantive shift in the mixed economy of healthcare in which commercial healthcare service provision and financing are increasing. However, while the internationalisation of healthcare service firms is a key element in helping to drive some of this change, the changes are ultimately highly dependent on state-level decision making and regulation. In this context, the thesis argues that globalisation presents an inadequate and potentially misleading conceptual framework for analysing these changes without a historical grounding in the particular developments of national and international markets for healthcare services.