Public Health Systems in the Age of Financialization

Lessons from the Center and the Periphery


In Public Health Systems in the Age of Financialization, Ana Carolina Cordilha unpacks policy shifts that have transformed public health systems into vehicles for financial speculation and capital accumulation. While it is commonly thought that these systems are being cut back in the period of financialization, the author shows that current changes in public health financing go far beyond budget cuts and privatization measures. She examines how public health systems are adopting financial instruments and participating in financial accumulation strategies, with harmful impacts on transparency, democratic accountability, and health service provision. With an in-depth study of both the French and Brazilian systems, Cordilha explores the different ways in which this process unfolds in central and peripheral countries.

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Ana Carolina Cordilha, Ph.D. (2022), Sorbonne Paris Nord University, teaches Quantitative Methods and Economic Development at Sorbonne Nouvelle University. She has several publications on financialization and social policy, including Financialisation and Public Health Systems: a new concept to examine ongoing reforms (2022).

List of Figures and Tables



Part 1
Financialization as a New Concept to Examine Public Health Systems Change
1Financialization and Its Inroads into Public Policy
 1 Finance and Its Workings
 1.1 Conventional Views of Finance

 1.2 The Heterodox Critique

 1.3 The Academic Scholarship on Financialization

 2 Together But Different: Financialization in Central and Peripheral Countries
 2.1 Financialization in France

 2.2 Financialization in Brazil

 3 Financialization and Social Provision
 3.1 The Inroads of Finance in Areas of Social Provision

 3.2 The Financialization of Social Policy

 3.3 The Financialization of the State

 3.4 Financialization and Central Governments: Changes in Public Debt Management

 3.5 Emerging Themes on State Financialization: Local Governments, Public Investments, and Social Provision

2Public Health Systems in Times of Financialization
 1 Public Health Systems ( phs )
 1.1 Reasons for State Intervention in Health Care

 1.2 Defining Public Systems

 1.3 Common Institutional Arrangements of  phs 

 1.4  phs  in Historical Perspective

 2 Conventional Approaches to Assess Health Systems Change
 2.1 Deconstructing the Notion of Privatization

 2.2 Agents

 2.3 Narratives

 2.4 Theoretical Underpinnings

 2.5 Impacts

 3 Financialization in the Health Sector
 3.1 The State of the Art of the Health Financialization Literature

 3.2 Investment Platforms: a New Approach to Finance Global Health Policies

 3.3 Ownership Restructuring: Reshaping the Landscape of Private Health

 3.4 Financial Innovations: a Novel Strategy for Public and Non-profit Agencies

 3.5 Gaps in the Existing Research for the Public Sector

 3.6 Financialization as a Distinctive Type of  phs  Change

 3.7 Agents

 3.8 Narratives

 3.9 Theoretical Underpinnings

 3.10 Different Paths, Same Driving Force: Austerity Policies

 3.11 Impacts of Financialization

 3.12 Bridging Concepts Together: Privatization as a Driver of Financialization

 3.13 Financialization as a Driver of Privatization

Part 2
From Theory to Practice: How Financialization Reshapes Public Health Systems
3The French System Pioneering Financialized Strategies in  phs 
 1 Social Security and Public Health Care in France
 1.1 The French System of Social Security

 1.2 The French Public Health System: Assurance Maladie

 1.3 The Trajectory Toward Universalization

 1.4 The Path of Neoliberal Reforms in Assurance Maladie

 1.5 Assurance Maladie’s Accounts in Perspective

 2 Mechanisms of Financialization
 2.1 Financialized Strategies for Long-Term Debt Management: the Social Debt Amortization Fund

 2.2 Contextualizing  cades ’ Creation

 2.3 Deconstructing  cades ’ Strategy

 2.4  cades  in Numbers

 2.5 Instruments and Costs

 2.6 Investors and Intermediaries

 2.7 State Support

 2.8 Financialized Strategies for Short-Term Financing by the Central Agency of Social Security

 2.9 Contextualizing the Adoption of Financialized Practices by the Central Agency

 2.10  acoss ’ Financing Strategy in Numbers

 2.11 Instruments and Costs

 2.12 Investors and Intermediaries

 2.13 State Support

 2.14 Government Policies Toward Hospitals: Credit-Based Investment Programs

 2.15 The French Hospital Sector at a Glance

 2.16 Bringing Hospitals and Banks Closer Together: a New Approach to Finance Investments

 2.17 Delving into the Credit-Based Financing Strategy

 2.18 The Role of the State

 2.19 Addendum: Public Hospitals Venturing into Financial Markets

 2.20 Financing Conditions and Intermediaries

 3 Taking Stock

4The Brazilian System A Trajectory (Mis)led by Financialization
 1 Social Security and Public Health Care in Brazil
 1.1 The Brazilian Social Security System

 1.2 The Brazilian Public Health System: Sistema Único de Saúde

 1.3 The Quest to Consolidate Universal Health Care: Successes and Drawbacks

 1.4 The Public Health System Today

 1.5  sus  Accounts in Perspective

 2 Mechanisms of Financialization
 2.1 Public Health Revenues Feeding Financial Accumulation: Policies at the Federal Level

 2.2 The 1999 Monetary Policy Regime and Its Associated Fiscal Policy Framework

 2.3 Reinforcing the Macroeconomic Regime: Health Spending Rules

 2.4 Backing the Macroeconomic Regime: Rules for Social Security Revenues

 2.5 Data Analysis and Interpretation: Health and Financial Expenditures in Perspective

 2.6 The Role of Financial Institutions

 2.7 Investing  sus  Revenues in Short-Term Financial Assets: Policies at the Subnational Level

 2.8 The Role of Health Funds

 2.9 The Rio de Janeiro State Health Fund

 2.10 The Federal District Health Fund

 2.11 When the Financial System Overrides the Health System: Revenue Retention Practices

 2.12 Subsidized Credit Lines for  sus  Providers

 2.13  sus  and the Philanthropic Health Sector

 2.14 Government Programs Connecting Philanthropic Hospitals and Banks

 2.15 Consigned Credit for Philanthropic Health Establishments

 2.16 The Bank-Based Strategy in Numbers

 2.17 How Credit-Based Hospital Financing Serves the Financial Sector

 2.18 Taking Stock

5Uncovering the Hidden Costs of Financialized Public Health Insights from Case Studies
 1 Systematizing Results: Common Trends

 2 Shared Trends, Unique Expressions: Contrasting Central and Peripheral Experiences

 3 A Broader View of Financialized Policies in phs and the Role of the State

 4 Impacts of Financialized Policies on the Foundational Principles of phs

Appendix Additional Information on Data Sources and Treatment



Scholars and professionals interested in public health and social policies, along with those concerned with the topic of financialization.
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