Governance for Health Care in Globalization - Essay Example

Governance for health care in globalization Governance is a word synonymous with structural analysis from a non social perspective. However, there are several reasons to study about governance from a social perspective, due to its implications in the development of policy and disciplines in the society. There are positive as well as negative implications for governance. This is because of the direct impact of governance on decision making and the ability of a government to interconnect various levels of actors for policy implementation and analysis. The drawback of governance lay in the ineffectiveness of governance in the society and raises questions whether the social policies surpass government and state policies. The term governance is being envisaged with a universal impact in the political scenario. Governance has its beginning in social administration and stands for well defined framework for any social policy. Social administration can be defined as the development of collective action to improve social welfare. In short, governance may be defined as an institution of collective action. Therefore governance and social policy have a key role to fulfill social requirements. It is also necessary to draw out a limit where governance can be implemented efficiently for a specific discipline. This indicates that governance should take a new form for social administration. In other words governance poses new questions whether it should limit its services to management and organization, whether it should follow a descriptive approach or whether it is a concept that understands the social character of policy. Thus, it is essential to analyze the relationship between various actors in the society that contributes to the implementation of governance. These actors are found in various level of the state. They are regional, national and local levels. These actors further comprise various interest groups in the implementation of collective action. Governance therefore should find logic in implementing its social policies according to the capacity of each actors of the society to enhance effectiveness. Governance is a concept that undergoes change from time to time. It is widely used in the field of politics to coordinate various types of public private communication. The term government imposes direct control on a society while governance imposes a network type of control to a process and a collection of agents. Governance refers to the changing character of government and is specific to a region and application of power. The term also signifies changes in the public sector and the distribution of control and power in the society and also indicates the changing arrangements in the society. Governance has taken shape from three main aspects. They are international political economy, globalization and international organizations. The change in governance is attributed to changes in domestic political scenario and the shift of authority from traditional set up of government to transnational organizations and the penetration of power to local and sub-region levels. Government implies central themes. The first theme is the capacity of the government to exercise control on society and the results arising from the power of the government in enhancing collective interest from the accountability of the government. The second theme is globalization. Globalization is the shift of power from local governments to international markets, supra national institutions and global companies. The rise of globalization has erased the region based approach of governance. This also diminishes the power of the state and gives rise to hegemony in the social structure and policy. The European Union is a distinctive case when it comes to new type of governance. The European Union extends the governance from the respective nation state to a group of nations with a well defined framework of organization for governance and serves as the pioneer in the field of planned democracy. The function of European Union cannot be related to an internation organization or any other type of polity but it has developed a new concept called multi-level governance for policy making and application that spread across a number of levels. In the multi level governance process there are a number of actors who contribute to policy making. They are the Union, international and sub national agents and national governments. In the case of European governance is carried out through delegates and representatives from member nations who meet in councils, boards and committees to set up standards, goals and interpret values. Thus governance embraces the use of soft power. By implementing policies through European Union there is less scope for politics and external agencies that provide service. From a post structuralist perspective governance is the method of attempting to manage or control a know matter (Daly, M. 2003 p.113-128) With the onset of globalization, international health governance is undergoing massive changes to its structure. This is in view of global health risk and the increasing problem of health inequality around the world. The increase in health care requirements has decreased the capacity of individual nations to address health issues. Governance is a new method of social health policy that overlaps foreign and domestic policies, bilateral and multilateral decisions and international and national interest while dealing with a particular health problem. This is substantiated by improving global participation in the field of health care. Major reforms in health governance started since the launch of Health for all strategy by the World Health Organization in the early 1980s. The change in governances is not as a result of politics but it has gained momentum in the wake of Trans-national health issues that has caused panic to politician and the public. The change in governance is envisaged as a measure of the WHO to implement a creative and well defined strategy for health care that transcends region, politics or specific agency. The method of implementing such a global measure has always raised question among the concerned though the international measure requires reinvention of policies to deal with the new global health phenomenon. For this reason, governance has transcended nations and paved way for several international agreements and transnational policy networks. Non government organizations play a vital role in the meeting of United Nations to apply the policies with a philanthropic approach by entering into partnership with the wide network of United Nation's system. The emerging health governance policy is more of a network than an agency that solves the issue of accountability and responsibility of all concerned. Further, the term international governance for health is giving way to the new global health strategy. The global perspective is attained when the policies of several nations overlap with the policies of other nations. The society and private sector is moving towards a new system of power where transnational policies are given due significance for the role of accountability and agency. These policies are usually recognized with globalization because it forms the base for the new form of health issues. There are two concepts that arise from the assumption that globalization has enhanced interdependence of nations. One concept indicates the cooperation and interdependence between nations is the willingness to work collaboratively with a rational interest without causing a change to the policy making capability. Another concept argues that globalization decreases internal sovereignty of a country by pooling policies and materials that serves as a protectionists approach with advanced competition. As regards, health governance both the concepts make a sense. When a country is ravaged by infectious disease it has to rely on quantitative measures to control the infection and are more willing to revise health regulations. This indicates interdependence. However the actual impact of globalization can be seen when the basic qualitative policy of a nation is transformed to suit international policies. Globalization is not a disguised phenomenon on health policies. Though globalization of economy is accelerated by political and social influence through WTO, globalization of health policy has not gained much momentum to implement a good framework of health governance and accountability. The formation of World Health Organization after the Second World War has been with a universalistic objective to eradicate and control diseases. By the 1970's these basic objectives attained wider application in the form of values, rules and perceptions for national and international health policy. The Alma Ata Declaration pointed out that government is accountable for the health of its people. This was followed by the WHO declaration that health policy is an inevitable part of modernization and that it would require all nations to establish a policy. The WHO defined the health issue and offered solution for reinventing policies and acted as an exclusive agency that assisted the application of technical programs to develop health policies. The new policies were also aimed to provide an economically and socially productive life to people when there was an increase in the number of independent developing nations. Gradually, the politicizing of health policy changed the objective of WHO from eradication and control to health management in the society. Therefore health became the agenda for human rights activists with the Health for all slogans and enhanced health care as a universal right. After the economic growth in 1970s the WHO had made deliberate attempts to substantiate proper health in developing nations in line with Health for all (HFA) policies that improved sanitation and water, child and maternal health, education, nutrition and housing. The policy makers of HFA internationalized and institutionalized the accountability of global health by setting up indications that measured health outcomes on national level. All the nations were required to report about health status on a regular basis. World Health Report held national government accountable for health policies. To substantiate the objectives of HFA, donor agencies also played a crucial role in assisting nations. Though accountability holds actors accountable for actions, international accountability has not attained a good level of action. This is because basic infrastructure needs to implement health policies is not available in nations outside Europe. Infrastructure facilities were unavailable even in developing countries (Kickbusch, I. 2000 p.979-989). The involvement of third party or indirect government in health care has a longstanding history. The use of third party government evolved as a principal agent and trust based relationship to solve information divide and was practiced on a contractual relationship with key roles played by well informed participants. The performance of third party governance is evaluated in the case of loosely associated networks to increase the accountability of the actors. There are three models that indicate the participation of government in substantiating a good health care policy. The three models are based on governance, agency and contract. During the major part of the twentieth century, governments functioned as a principal in the health care sector on the basis of principal agent association. Policies about revision and allocation of health care were provided by health care professionals like physicians who were given the authority to carry out health care efficiently. The basis of the criteria is from the microeconomics of health care that has the central role of agency based relationship that exists between the patient and physician. In 1963, Kenneth Arrow has debated about this model in the article 'Uncertainty and the Welfare Economics of Medical Care'. Features like information unevenness, assessment of product and high cost of mistake drives health consumers to get into an agency relationship with health care providers. Therefore, physicians are given the authority to make the right decision for a particular patient in the best interest based on the feature of trust. Unlike other relationships where people get into a contract with agencies patients cannot enter into a contract due to the risks associated with the outcomes of treatment. This has led physicians to act as central players in the decision making process in health care. The relationship is recognized on the basis of ethical rules that hold the physician responsible for possible abuse of power in their position. Later the authority of physicians was controlled by a professional body that takes care of the conduct of its members. Hence the responsibility of the state is to ensure good quality care and reinstate it through the second level association as agency with professional groups. Health care sector received large scale financing that has implication on the second level agency association. Firstly, it requires high quality services. Secondly, the finances offer government a stake in the expenses and quality of health services. Thirdly, the finance offers prospects to gather database of consumers that serve as records to offer government programs for health coverage. This facility was not much used until information technology enabled the use of these databases. The availability of administrative database and the facilities of information technology enabled government to control costs. The government of various countries negotiated with health care companies to offer health services based on contracts. This is how the agency model evolved into a contract model of responsibility that gained momentum in 1990s. Governments posed as a purchaser of health services by entering into contract for specific health deliverables. The popularity of contract model increased the participation of private sector in health care that stood with equal importance to public sector services in advanced nations. The unprecedented growth of contract based health care system based on information systems showed that health care was also developing in line with globalization. The globalization dimension is applicable to health care due to the increase in the number of pharmaceuticals and the surge of health care as an global competitive industry with liberal trade arrangements. International mobility that spread disease also contributes to the globalization of health care. Therefore it has become imperative for governments to adopt a global stand for health care governance that associates social and economic arena. Regulations and policies that assist governments to hold health service providers responsible through agency or contract relationships which is superior to the traditional system of control. Thus indirect governance takes shape and signifies its part in global health care. The interpenetration of health care institutions and the institutions of nations is not a democratic process but a pre-democratic one. This requires health care segment to adjust to democratic policies of the government to function effectively (Tuohy, C.H. (2003) p.195-215). Stewardship function in health care is related to two concepts: what are the process to be followed and how the process should be implemented. Health care governance gives more stress to acceptable activities of the government in planning assessment, supervision, regulation and policy making. For instance transparent and participatory approach is envisaged as a method of good governance. Stewardship also refers to the ability of the government to plan and implement good policies and accountability (Travis et al 2002). Health care governance comprises political involvement in the case of Malarone Donation programme introduced in Kenya. The donation program instituted by Glaxo-Wellcome to treat Plasmodium falciparum that kills almost one million people annually in Africa has to face structural problems in the society irrespective of the social initiative involved in the program. The program was a success though it encountered infrastructure and logistic problems initially. The implementation of programme received the attention of various other enthusiastic companies to partner in the donation program. This indicates that any health governance program will receive recognition and further lead to expansion with the pooling of resources. The donation program however received a set back due to political interference in terms of areas of administration. Since the medication was a free supply, people were also apprehensive about the effect of the medicine because it was not channeled through organized medical centers of the country. Further, the donation program is a good example of private public partnership in contracting health care service to voluntary organizations. The good governance policy faces challenge if there are no adequate resources to support donation programs. Purpose, partnership and program are the three words that should accompany donation programs to ensure effectiveness those results from balance of power and nature of the state. The leakage of medicines in the MDP program from public sector health service to private sector serves as an example to ensure additional safety methods while implementing donation programs (Shretta, R., G walt, et al.(2001) p.161-170).The effect of health governance may be analyzed with reference to the health care policy in Korea. The Korean government established a financing program in 1999 that connected provider payment and pharmaceuticals that merged over three hundred and fifty health insurance companies as a single entity, setting up a new payment methods in the best interest of the public overriding vested interests of physicians and politicians (Kwon, S & Reich, M.R. 2005 p.1003-1026). It may be concluded that governance of health care from a globalization perspective is not a simple task. It requires the involvement of the nation and various actors who act in their capacity as agents or contractors to deliver best health care services to people around the world. The word globalization should be considered with a positive vision due to the aspect of international collaboration entailed in controlling and eradicating diseases with the cooperation of private and public sector actors like pharmaceutical companies and governments. Hence globalization of health care is a positive phenomenon if it obtains necessary assistance from concerned government where there is a health issue since it pools resources and shares knowledge for a better living of mankind around the world. Reference: Daly, M. (2003) "governance and social policy" journal of Social policy 31(1):113-128 ' Kickbusch, I. (2000) "the development of international health policies-accountability intact'" Social science and medicine 51: 979-989 Kwon, S & Reich, M.R. 2005 The Changing Process and Politics of Health Policy in Korea. Journal of Health Politics, Policy and Law 2005 30(6):1003-1026 Available: http://jhppl.dukejournals.org/cgi/content/abstract/30/6/1003. Accessed on December 17, 2008 Shretta,R., G walt, Brugha, R. & Snow, R.W. (2001) "A political analysis of corporate drug donations: the example of Malarone in Kenya" health policy and planning 16(2):161-170 Travis, P., Egger, D., Davies, P. & Mechbal, A. 2002Towards better stewardship: concepts and critical issues. Evidence and Information for PolicyWorld Health Organization, Geneva Tuohy, C.H. (2003) "agency, contract and governance:shifting shapes of accountability in the health are arena." Journal of health Politics, policy and law 28(2-3):195-215 Additional reference Bettcher, D. & Lee, K. 2002 Globalization and public health. Journal of Epidemiology and Community Health Vol 56 p.8-17. Available: http://jech.bmj.com/cgi/content/abstract/56/1/8. Accessed on December 17, 2008 Huynen, MM, Marten, P & Hilderink, HB. 2005. The health impacts of gloabisation: a conceptual framework. Globalization and Health. Vol.1. Iss.14 Availabel: http://www.globalizationandhealth.com/content/1/1/14. Accessed on December 17, 2008 Peabody, J.W., Leec, S & Bickeld, S.R. 1994. Health for all in the Republic of Korea: one country's experience with implementing universal health care. Health Policy. Vol.31. Iss.1. p.29-42. Available: http://www.journals.elsevierhealth.com/periodicals/heap/article/0168-8510(94)00669-6/abstract . Accessed on December 17, 2008 Read More