Certain wealth: accumulation in the health industry

Abstract

There is growing disquiet over market incursions into the arena of health delivery and the transformation of health care into a commodity. The global health industry at the centre of this has become increasingly visible, raising critical questions about the structural integrity and survival of health systems everywhere.  Despite these palpable concerns, capturing an image of the private health industry as a whole is as overwhelming as it is complicated. It is difficult to determine which social processes should or should not be included, and the blurred lines between public activity and private accumulation make strict identifications of the industry near impossible. By way of example, private social insurance funds can be non-profit, with a clear public interest, but can also be amenable to being converted into internal markets and, ultimately, entering into for-profit competition. Still, it is important not only to try to map the most important elements of this industry, but also to consider its politico-economic strategies in relation to existing public-private health system configurations. This essay contends that the health industry, while undoubtedly encouraging a uniform trend toward private accumulation of ‘wealth in health’, settles for pragmatic strategies of institutional adaptation that optimise its returns within existing political conditions. To the degree that expanding accumulation meets with blockages, commercial health ‘providers’, in particular, seek ways of harnessing prevailing political and institutional arrangements towards their most profitable ends.