Public Health Systems in the Age of Financialization

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).

• AcknowledgmentsList of Figures and TablesAcronymsIntroductionPart 1Financialization as a New Concept to Examine Public Health Systems Change1 Financialization and Its Inroads into Public Policy1 Finance and Its Workings1.1 Conventional Views of Finance1.2 The Heterodox Critique1.3 The Academic Scholarship on Financialization2 Together But Different: Financialization in Central and Peripheral Countries2.1 Financialization in France2.2 Financialization in Brazil3 Financialization and Social Provision3.1 The Inroads of Finance in Areas of Social Provision3.2 The Financialization of Social Policy3.3 The Financialization of the State3.4 Financialization and Central Governments: Changes in Public Debt Management3.5 Emerging Themes on State Financialization: Local Governments, Public Investments, and Social Provision2 Public Health Systems in Times of Financialization1 Public Health Systems (phs)1.1 Reasons for State Intervention in Health Care1.2 Defining Public Systems1.3 Common Institutional Arrangements of phs1.4 phs in Historical Perspective2 Conventional Approaches to Assess Health Systems Change2.1 Deconstructing the Notion of Privatization2.2 Agents2.3 Narratives2.4 Theoretical Underpinnings2.5 Impacts3 Financialization in the Health Sector3.1 The State of the Art of the Health Financialization Literature3.2 Investment Platforms: a New Approach to Finance Global Health Policies3.3 Ownership Restructuring: Reshaping the Landscape of Private Health3.4 Financial Innovations: a Novel Strategy for Public and Non-profit Agencies3.5 Gaps in the Existing Research for the Public Sector3.6 Financialization as a Distinctive Type of phs Change3.7 Agents3.8 Narratives3.9 Theoretical Underpinnings3.10 Different Paths, Same Driving Force: Austerity Policies3.11 Impacts of Financialization3.12 Bridging Concepts Together: Privatization as a Driver of Financialization3.13 Financialization as a Driver of PrivatizationPart 2From Theory to Practice: How Financialization Reshapes Public Health Systems3 The French System Pioneering Financialized Strategies in phs1 Social Security and Public Health Care in France1.1 The French System of Social Security1.2 The French Public Health System: Assurance Maladie1.3 The Trajectory Toward Universalization1.4 The Path of Neoliberal Reforms in Assurance Maladie1.5 Assurance Maladie’s Accounts in Perspective2 Mechanisms of Financialization2.1 Financialized Strategies for Long-Term Debt Management: the Social Debt Amortization Fund2.2 Contextualizing cades’ Creation2.3 Deconstructing cades’ Strategy2.4 cades in Numbers2.5 Instruments and Costs2.6 Investors and Intermediaries2.7 State Support2.8 Financialized Strategies for Short-Term Financing by the Central Agency of Social Security2.9 Contextualizing the Adoption of Financialized Practices by the Central Agency2.10 acoss’ Financing Strategy in Numbers2.11 Instruments and Costs2.12 Investors and Intermediaries2.13 State Support2.14 Government Policies Toward Hospitals: Credit-Based Investment Programs2.15 The French Hospital Sector at a Glance2.16 Bringing Hospitals and Banks Closer Together: a New Approach to Finance Investments2.17 Delving into the Credit-Based Financing Strategy2.18 The Role of the State2.19 Addendum: Public Hospitals Venturing into Financial Markets2.20 Financing Conditions and Intermediaries3 Taking Stock4 The Brazilian System A Trajectory (Mis)led by Financialization1 Social Security and Public Health Care in Brazil1.1 The Brazilian Social Security System1.2 The Brazilian Public Health System: Sistema Único de Saúde1.3 The Quest to Consolidate Universal Health Care: Successes and Drawbacks1.4 The Public Health System Today1.5 sus Accounts in Perspective2 Mechanisms of Financialization2.1 Public Health Revenues Feeding Financial Accumulation: Policies at the Federal Level2.2 The 1999 Monetary Policy Regime and Its Associated Fiscal Policy Framework2.3 Reinforcing the Macroeconomic Regime: Health Spending Rules2.4 Backing the Macroeconomic Regime: Rules for Social Security Revenues2.5 Data Analysis and Interpretation: Health and Financial Expenditures in Perspective2.6 The Role of Financial Institutions2.7 Investing sus Revenues in Short-Term Financial Assets: Policies at the Subnational Level2.8 The Role of Health Funds2.9 The Rio de Janeiro State Health Fund2.10 The Federal District Health Fund2.11 When the Financial System Overrides the Health System: Revenue Retention Practices2.12 Subsidized Credit Lines for sus Providers2.13 sus and the Philanthropic Health Sector2.14 Government Programs Connecting Philanthropic Hospitals and Banks2.15 Consigned Credit for Philanthropic Health Establishments2.16 The Bank-Based Strategy in Numbers2.17 How Credit-Based Hospital Financing Serves the Financial Sector2.18 Taking Stock5 Uncovering the Hidden Costs of Financialized Public Health Insights from Case Studies1 Systematizing Results: Common Trends2 Shared Trends, Unique Expressions: Contrasting Central and Peripheral Experiences3 A Broader View of Financialized Policies in phs and the Role of the State4 Impacts of Financialized Policies on the Foundational Principles of phsAppendix Additional Information on Data Sources and TreatmentReferencesIndex