The proprietarization of health care and the underdevelopment of the public sector

Failure of hospitals in urban areas is a well documented, spreading phenomenon that is resulting in decreased care for the medically indigent. As financial conditions force greater closures and cutbacks among providers, this dismantling of institutions that have historically served the unfortunate deepens the crisis in access to medical care. In this article, pressure on private health care institutions to adhere to a more bottom-line approach is viewed in the light of an overall attempt by government to divert public capital into private sector coffers, a trend that is particularly significant because of the ongoing concentration and centralization within the delivery system. Set in a historical analysis of the corporatization of health care, a case is made to reveal the underdevelopment of public hospitals, certain urban voluntary institutions, and community-based clinics, i.e., those institutions left to serve the most needy, in the face of rampant financial success by proprietary providers catering to a middle-class clientele requiring less intensity of care.