Projects

Projects

Development Aid and Beyond

Health and healthcare have historically been major targets for development aid spending by wealthy countries. Over the past 20 years this scenario has evolved as new donors have emerged and older donors have pursued ‘beyond aid’ agendas. We consider the scale of the changes taking place and the forms of healthcare being financed.

The Global Healthcare Economy

A recent phase of healthcare expansion, something intensified by the COVID-19 pandemic, is driving the emergence and evolution of a range of new local and global markets. From the growth of insurance and digital platform industries, to the “medicities” or “health cities” being constructed in various settings, we study these changes and the implications for how healthcare systems are organised.

Transnational Engagements in China, India and the UK

Healthcare is increasingly seen as an area that can deliver significant financial returns, particularly through international trade in health-related services. As a result some governments are actively promoting healthcare as a strategy for national economic development. In this project, we examine attempts by public and private institutions to build connections across borders and position countries within global markets.

Corporatisation and Regulation in India’s Private Healthcare Sector

The growth of healthcare industries poses a challenge to established ways of working within healthcare systems. Provision and regulation in the sector are being reshaped by business and management practices, necessitating better understanding of these processes and their implications for access and accountability. This project studied these changes in the context of India’s private healthcare sector.

Regulation in Turkey’s Pluralist Healthcare System

Many governments have been seeking private sector solutions in response to meeting the needs (and costs) of achieving universal healthcare coverage. This project examined these issues in Turkey, where private sector engagement has grown dramatically since the launch of the Health Transformation Program in 2003.

Vouchers and Cash Transfers

Voucher and cash transfers are expected to promote health by offsetting some associated financial costs or by increasing household income or providing financial incentives to increase healthy behaviours. We examined the design and effects of these policy initiatives to determine their role in creating and promoting healthcare markets, and the implications for equity.

Blog posts

Corporatisation and Regulation in India’s Private Healthcare Sector

Picture credit: John Isaac / World Bank, via Flickr

The Corporatisation and Regulation in the Private Healthcare Sector in India (CRiPS) project was concerned with the expansion and changing face of private sector hospital care and related diagnostic services through an organised, and increasingly transnational, healthcare industry. Using a detailed case study in Maharashtra State, India, the research aimed to: examine the implications of these emerging forms of healthcare delivery and their business and management practices for the healthcare sector and for practitioners and users of their services; consider the nature of past attempts at effective private sector regulation; and to advance the development of a social accountability framework for regulation of the sector.

CRiPS was a collaboration between King’s College London Department of International Development in London, and Support for Advocacy and Training to Health Initiatives (SATHI) in Pune. The project was conducted with support from the UK Joint Health Systems Research Initiative, funded by the UK Medical Research Council, Economic and Social Research Council, Department for International Development and Wellcome Trust.

Publications

Journal articles:

Guide and transcripts from project witness seminars:

Project team

Professor Susan Fairley Murray and Dr Indira Chakravarthi (lead investigators), Shweta Marathe, Deepali Yakkundi, Dr Abhay Shukla, Dr Benjamin Hunter, Dr Arun Gadre, Dr Sanjay Nagral

ESRC logoWT logoUKAid logo

 Image result for sathi punekcl-logo

The Global Healthcare Economy

Picture credit: Benjamin Hunter

A recent phase of healthcare expansion, something intensified by the COVID-19 pandemic, is driving the emergence and evolution of a range of new local and global markets. From the growth of insurance and digital platform industries, to the “medicities” or “health cities” being constructed in various settings, we study these changes and the implications for how healthcare systems are organised.

Commercial health insurance

Financial markets, actors, institutions and technologies are increasingly determining which kinds of services and ‘welfare’ are available and how these are narrated. We take an analytical lens to the growing global markets for commercial health insurance, asking why and how this financial technology is gaining in prominence as part of private sector solutions envisaged for public health problems in many countries.

Healthcare agents and platforms

People face difficult decisions when they try to access healthcare, yet they often lack reliable information with which to make those decisions. This provides commercial opportunities for intermediaries to facilitate – or ‘broker’ – access to healthcare. We examine how these systems of brokerage emerge in the healthcare sector and their implications for healthcare access. This includes work funded by the Wellcome Trust to consider the platform-based systems of brokerage that exist to facilitate domestic and international access to healthcare in Delhi and London.

Real estate

Urban transformations offer significant opportunities for real estate development and the building of healthcare facilities has been given high profile in modernisation discourse alongside condominiums, shopping malls, hotels and IT parks. Industrial or agricultural land use is being converted to accommodate construction of vast ‘medicities’ or ‘health cities’ – comprising super-speciality hospitals focused offering cutting edge technology for specific conditions (cardiology, nephrology, endocrinology, joint replacement), medical training facilities and laboratories. But who really benefits from these transformations? To date our work has focused on India, where a plethora of plans for “medicities” in different states have been announced in the press media since 2007.

 

Publications

On insurance:

  • Murray SF (Forthcoming). Commodified Health Regimes: The Promotion of Commercial Health Insurance in the Global South.

On healthcare agents and platforms:

On real estate:

Texts on the broader global healthcare economy:

Image result for wellcome trust

Vouchers and Cash Transfers

Picture credit: WHO/TDR/Andy Crump

Prospective users of health services in many countries face financial costs for transport and treatment and opportunity costs of receiving care, and such costs are well-documented barriers for the uptake of healthcare services. “Demand-side” financing in the health sector – such as voucher and cash transfers – was introduced to promote health by offsetting some associated financial costs or by increasing household income or providing financial incentives to increase healthy behaviours.

We have examined the design and effects of these policy initiatives to determine their role in creating and promoting healthcare markets, and the implications for equity. This research has been funded by AusAID and the World Health Organization Department of Maternal, Newborn, Child and Adolescent Health, and includes articles on the implementation of vouchers and cash transfers, and reviewing their effects. Together with Jasmine Gideon (Birkbeck), we published a critique and framework for gender analysis in the study of vouchers and public-private partnerships more widely (see blog here).

Publications

Who-logoPicture1

Development Aid and Beyond

Picture credit: epSos.de, via Wikimedia Commons

Health and healthcare have historically been major targets for development aid spending by wealthy countries. Over the past 20 years this scenario has evolved as new donors have emerged, including large philanthropic foundations and several emerging economies. At the same time, long-standing donors from OECD countries have adopted ‘beyond aid’ agendas that deploy a wider range of instruments in pursuit of health and development.

We consider the scale and forms of the changes taking place, and the implications for how healthcare systems are organised and run. This has included recent work on the converging roles of high- and middle-income states as investors in overseas healthcare sectors, the growing reach of the financial services sector in these markets, and the shifting operations of international organisations seeking to accommodate these changes. We seek to interpret and explain these changes using concepts such as financialisation and state capitalism, and maintain close connections with the New Frontiers in International Development Finance network based at the University of Warwick.

Publications

On the ‘beyond aid’ transition:

On aid:

Regulation in Turkey’s Pluralist Healthcare System

Picture: Ankara Bilkent City Hospital – the largest of Turkey’s ‘health campuses’. Credit: Metuboy, via Wikimedia Commons

Many governments have been seeking private sector solutions in response to rising costs of medical care and commitments to universal healthcare coverage. Healthcare is also increasingly viewed as an industry that can contribute to economic development. However, extensive private sector activity in healthcare brings new challenges in the public regulation of the sector. This project examined these issues in Turkey, where healthcare has undergone significant change since the launch of a Health Transformation Program in 2003.

The project was a collaboration between Bogazici University and King’s College London, conducted with support from the British Academy Newton Fund.

Publications

Project team

Dr Volkan Yılmaz (lead investigator) and Professor Susan Fairley Murray (co-investigator)

Newton International Fellowshipskcl-logo  Boğaziçi University - Wikipedia

 

Transnational Engagements in China, India and the UK

Picture credit: Microsoft Stock Image

Healthcare is increasingly seen as an area that can deliver significant financial returns, particularly through international trade in health-related services. As a result some governments are actively promoting healthcare as a strategy for national economic development. The Transnational Provisioning of Services in the Social Sector (TNP) project aims to improve understanding of transnational engagements between wealthy countries and emerging economies in the healthcare sector, and the domestic implications of these engagements. We address this through a detailed study of contemporary attempts by public and private actors in China, India and the UK to benefit from market opportunities for the trading in health-related services between these three countries.

In May 2023 we held a research symposium at King’s College London. Further details can be found here.

The project is a collaboration between researchers at King’s College London, University of Sussex and Jawaharlal Nehru University. It is conducted with support from the UK Economic and Social Research Council.

Policy briefs

Academic publications

  • Salter B, Dong Y and BM Hunter. (2022). Constructing healthcare services markets: networks, brokers and the China-England engagement. Globalization and Health

Project team

Professor Susan Fairley Murray (lead investigator), Professor Ramila Bisht, Professor Brian Salter, Dr Benjamin Hunter, Dr Yinhua Zhou (Co-Investigators), and Dr Yiming Dong and Dr Sibille Merz.

ESRC logokcl-logoFile:University of Sussex Logo.svg - Wikimedia CommonsFile:JNU logo.svg - Wikimedia CommonsSun Yat-sen University - Wikipedia

Symposium on Globalisation and Commercialisation in the Social Sectors

Service provision in social sectors such as healthcare, social care and education is most often considered within a national boundary, reflecting the origins of these sectors in an era in which the nation-state was the pre-eminent form. However, the interplay of commercialisation and globalisation is producing significant changes in the political economy of these sectors, including the expansion of global markets for services, cross-border provision by public and private institutions, and new state-market engagements to promote exporting and importing. This one-day research symposium seeks to bring together researchers who are studying this area to unpack and critique these developments in different social sectors. It will invite multi-disciplinary perspectives, aiming to generate discussion and stimulate learning across boundaries. See the Call for Abstracts for further information. A set of blogposts produced by the symposium participants to set out some initial thoughts for discussion are linked below.

Symposium blogposts

Benjamin Hunter – Beyond borders

Ana Carolina Cordilha – Beyond austerity and privatisation: bringing financialisation into the analysis of neoliberal reforms

Jian Wu – International student mobility in an era of globalising and neoliberlised higher education: contested landscapes of global flows

Ramila Bisht – Transnational markets in medical education and training

Elaine Unterhalter and Jasmine Gideon – Comparing health and education: some possibilities of conceptual and methodological approaches to comparison in the study of transnational processes

María Fernanda Rodríguez – The market and the state: revealing arguments for, and orders of worth of the struggle over the regulation of private education in Peru

Sibille Merz – Studying transnational markets in health education through a moral economy lens

Margaret Walton-Roberts – Globalisation and commercialisation in social sectors: connecting global care chains and global value chains

Julia Ngozi Chukwuma, Maria Jose Romero and Elisa Van Waeyenberge – The financialisation of healthcare: the World Bank’s role in promoting public-private partnerships in health

Hannah Moscowitz – The nation state in the global higher education market

Yiming Dong – Market-makers in China’s healthcare sector

Mariano Rosenzvaig – Unravelling the complexity of making and unmaking education markets

The symposium is being organised by Susan Fairley Murray, Susan Robertson and Benjamin Hunter.