Power and Resistance: Privatising Postcommunist Health
Sociology University of Cambridge UK, http://www.nowahutastudy.info
It has become almost axiomatic among some international policy experts that one source of support for the current global shift in favour of the liberalisation of health care and the formation of two-tier health care systems is the widespread repudiation, after communism, of all things associated with that regime. Yet of all the momentous changes that have taken place in postsocialist Europe over the last two decades, perhaps the most contentious have been in the field of health care. Nowhere has this been more obvious than in Poland, where the struggle over the privatization of health services has lasted around ten years, in fact, ever since the introduction in 1999 of major health care reform. This paper puts forward a framework within which to analyse health care transformation in postcommunist Europe, highlighting the way in which such transformations differ from the liberalisation of health care in the West. Rather than erasing the frictions which have become an integral feature of health care transformation within Poland, the paper examines what lies behind them, and why they remain relatively invisible to transnational health policy discourse. The aim is to gain insight into the social processes health care transformation has involved in practice. Why has it provoked such resistance, and what is the relevance for a European health discourse which currently emphasises empowerment, the preservation of equity and the importance of trust? In addressing these questions the paper draws on interviews and on official and media reports collected before, during and after health care reform.