Global Health in the Grip of Neoliberalism: A Combined Retrospective Comparative Stages Heuristic Policy Analysis

Background: The COVID-19 pandemic revealed critical weaknesses in global health systems, many of which have roots in the neoliberal policies that have dominated global health governance since the 1980s. Neoliberalism, characterized by market-driven policies, privatization, and reduced government intervention, has profoundly impacted healthcare access, equity, and quality worldwide.

Objective: This study aims to analyze the impact of neoliberal reforms on health systems in various countries, focusing on the interplay between governance, policy formulation, and stewardship in the health sector. By examining the outcomes of these reforms, the study seeks to understand how different approaches to neoliberalism have shaped health system performance and equity.

Methods: The study employs the Stages Heuristic Model (SHM) to conduct a retrospective comparative analysis of health policy reforms in ten countries, including the United States, Chile, New Zealand, Ecuador, and China. The research synthesizes data from peer-reviewed articles to assess the outcomes of neoliberal policies on healthcare systems.

Results: The analysis reveals that in countries such as the United States and Chile, neoliberal reforms led to increased health inequities and a tiered healthcare system, where access to quality care became increasingly dependent on socioeconomic status. In contrast, countries like Taiwan, which balanced neoliberal reforms with strong public health initiatives, managed to maintain more equitable health systems. China and Venezuela, both of which initially adopted more interventionist healthcare policies, made notable early strides in improving access to healthcare and addressing inequities, particularly for underserved populations. However, Venezuela's progress was undermined by economic challenges and insufficient support for higher-level care, leading to a decline in health outcomes over time.

Conclusion: The study underscores the need for governance models that prioritize equity and public health in healthcare systems. It suggests that while neoliberal policies can drive economic efficiency, they often do so at the cost of health equity, necessitating a re-evaluation of global health governance and policy approaches.