Global Health in the Grip of Neoliberalism: A Combined Retrospective Comparative Stages Heuristic Policy Analysis
Main Article Content
Abstract
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.
Keywords:
Neoliberalism, health reform, economic reform, health inequity, social safety net, austerity measures, privatization
Article Details
How to Cite
MATARIA, Wafa Abuelkheir; CHUN, Sungsoo.
Global Health in the Grip of Neoliberalism: A Combined Retrospective Comparative Stages Heuristic Policy Analysis.
Medical Research Archives, [S.l.], v. 12, n. 11, nov. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5843>. Date accessed: 12 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i11.5843.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Haldane V, De Foo C, Abdalla SM, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021;27(6):964-980.
2. Almeida A. The trade-off between health system resiliency and efficiency: evidence from COVID-19 in European regions. Eur J Health Econ. 2024;25(1):31-47. doi:10.1007/s10198-023-01567-w
3. Maani N, Galea S. COVID-19 and underinvestment in the public health infrastructure of the United States. Milbank Q. 2020;98(2):250.
4. David Williams O, Yung KC, Grépin KA. The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems. Glob Public Health. 2021;16(8-9):1320-1333. doi:10.1080/17441692.2021.1874470
5. Vallier K. Neoliberalism. Published online 2021. Accessed March 30, 2024. https://plato.stanford.edu/entries/neoliberalism/?ref=amonle.com
6. Evans P, Sewell WH. The neoliberal era: Ideology, policy, and social effects. Soc Resil Neoliberal Era. Published online 2013:35-68.
7. McGregor S. Neoliberalism and health care. Int J Consum Stud. 2001;25(2):82-89.
8. Lasswell HD. The political science of science: An inquiry into the possible reconciliation of mastery and freedom. Am Polit Sci Rev. 1956;50(4):961-979.
9. Brewer GD, DeLeon P. The Foundations of Policy Analysis. Brooks/Cole Publishing Company; 1983. https://books.google.com.eg/books?id=Vq7uAAAAMAAJ
10. Adelle C, Jordan A, Turnpenny J. Policy making. In: Environmental Policy in the EU. Routledge; 2012:235-252. Accessed April 2, 2024. https://www.taylorfrancis.com/chapters/edit/10.4324/9780203109823-25/policy-making-camilla-adelle-andrew-jordan-john-turnpenny
11. Collier D. The comparative method. Polit Sci State Discip II Ada W Finifter Ed Am Polit Sci Assoc. Published online 1993. Accessed April 14, 2024. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1540884
12. Stafford A. Comparative analysis within political science. E-Int Relat. 2013;1(4).
13. Levy FD. Chile: an economy in transition. World Bank Ctry Study USA. Published online 1983.
14. Gideon J. Counting the cost of privatised provision: Women, rights and neoliberal health reforms in Chile. IDS Bull. 2008;39(6):75-82. doi:10.1111/j.1759-5436.2008.tb00514.x
15. Rotarou ES, Sakellariou D. Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile. Health Policy. 2017;121(5):495-503.
16. Taylor M. The reformulation of social policy in Chile, 1973-2001: Questioning a neoliberal model. Glob Soc Policy. 2003;3(1):21-44. doi:10.1177/1468018103003001009
17. Tsai TC, Jl J. Neoliberalism and its discontents: Impact of health reforms in Chile. Harv Int Rev. 2009;31(2):32-36.
18. López-Cevallos DF, Chi C. Health care utilization in Ecuador: a multilevel analysis of socio-economic determinants and inequality issues. Health Policy Plan. 2010;25(3):209-218.
19. De Paepe P, Tapia RE, Santacruz EA, Unger JP. Ecuador’s silent health reform. Int J Health Serv. 2012;42(2):219-233. doi:10.2190/HS.42.2.e
20. Friederic K, Burke BJ. La Revolución Ciudadana and social medicine: Undermining community in the state provision of health care in Ecuador. Glob Public Health. 2019;14(6-7):884-898. doi:10.1080/17441692.2018.1481219
21. Mahmood Q, Muntaner C. Theoretical underpinnings of state institutionalisation of inclusion and struggles in collective health in Latin America. Glob Public Health. 2019;14(6-7):863-874. doi:10.1080/17441692.2018.1455886
22. Muntaner C, Salazar RMG, Rueda S, Armada F. Challenging the neoliberal trend: The Venezuelan health care reform alternative. Can J Public Health. 2006;97(6):1-19.
23. Misir P. Health care in guyana. Soc Med. 2015;9(1):36-47.
24. Seoane‐Vazquez E, Rodriguez‐Monguio R. Access to essential drugs in Guyana: a public health challenge. Int J Health Plann Manage. 2010;25(1):2-16. doi:10.1002/hpm.949
25. Walker A. Narrating health and scarcity: Guyanese healthcare workers, development reformers, and sacrifice as solution from socialist to neoliberal governance. Soc Sci Med. 2017;187:225-232.
26. Barnett R, Barnett P. Back to the Future? Reflections on past reforms and future prospects for health services in New Zealand. GeoJournal. 2004;59(2):137-147. doi:10.1023/B:GEJO.0000019972.22425.8d
27. Brown H, Bryder L. Universal healthcare for all? Māori health inequalities in Aotearoa New Zealand, 1975–2000. Soc Sci Med. 2023;319. doi:10.1016/j.socscimed.2022.115315
28. Zhang W, Navarro V. Why hasn’t China’s high-profile health reform (2003-2012) delivered? An analysis of its neoliberal roots. Crit Soc Policy. 2014;34(2):175-198. doi:10.1177/0261018313514805
29. Duckett J, Langer AI. Populism versus Neoliberalism: Diversity and Ideology in the Chinese Media’s Narratives of Health Care Reform. Mod China. 2013;39(6):653-680. doi:10.1177/0097700413492602
30. Epperson B. Challenging narratives to neoliberalism in media representations of American health reform: Lessons from the United States. In: Neoliberal Contentions: Diagnosing the Present. ; 2022:133-155. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85145427868&partnerID=40&md5=c0c6e2cb81017a46e872889ca559d896
31. Waitzkin H, Hellander I. The History and Future of Neoliberal Health Reform: Obamacare and Its Predecessors. Int J Health Serv. 2016;46(4):747-766. doi:10.1177/0020731416661645
32. Foley EE. The anti-politics of health reform: Household power relations and child health in rural Senegal. Anthropol Med. 2009;16(1):61-71. doi:10.1080/13648470802426243
33. Chen C fen, Fu T hsi. Policies and transformation of long-term care system in Taiwan. Ann Geriatr Med Res. 2020;24(3):187.
34. Lee C, Chen MS. Rescuing Public Health From the Global Capitalist Regime: The Public Health Liberation Movement in Taiwan. Am Behav Sci. 2024;68(3):322-337. doi:10.1177/00027642221134845
35. Tsai MC. Dependency, the state and class in the neoliberal transition of Taiwan. Third World Q. 2001;22(3):359-379. doi:10.1080/01436590120061651
36. Mudge SL. What is neo-liberalism? Socio-Econ Rev. 2008;6(4):703-731.
37. Lu JFR, Chiang TL. Evolution of Taiwan’s health care system. Health Econ Policy Law. 2011;6(1):85-107.
38. Tsung-Mei Cheng. Taiwan’s health care system: The next 20 years. Brookings. May 14, 2015. Accessed April 30, 2024. https://www.brookings.edu/articles/taiwans-health-care-system-the-next-20-years/
39. Sparke M, Williams OD. Neoliberal disease: COVID-19, co-pathogenesis and global health insecurities. Environ Plan Econ Space. 2022;54(1):15-32. doi:10.1177/0308518X211048905
40. Abu El Kheir-Mataria W, El-Fawal H, Chun S. Global health governance performance during Covid-19, what needs to be changed? a delphi survey study. Glob Health. 2023;19(1):1-13.
41. Jung AS, Haldane V, Neill R, et al. National responses to covid-19: drivers, complexities, and uncertainties in the first year of the pandemic. bmj. 2021;375. Accessed May 14, 2024. https://www.bmj.com/content/375/bmj-2021-068954.abstract
42. Chua AQ, Tan MMJ, Verma M, et al. Health system resilience in managing the COVID-19 pandemic: lessons from Singapore. BMJ Glob Health. 2020;5(9):e003317.
43. Mahendradhata Y, Andayani NLPE, Hasri ET, et al. The capacity of the Indonesian healthcare system to respond to COVID-19. Front Public Health. 2021;9:649819.
44. Bush RW. Reducing waste in US health care systems. Jama. 2007;297(8):871-874.
45. Relman A. Why the US healthcare system is failing, and what might rescue it. BMJ. 2012;344. Accessed May 20, 2024. https://www.bmj.com/content/344/bmj.e3052.full
46. Rice T, Rosenau P, Unruh LY, et al. United States of America: health system review. Published online 2013. Accessed May 20, 2024. https://apps.who.int/iris/handle/10665/330305?search-result=true&query=¤t-scope=10665%2F107132&filtertype_0=dateIssued&filter_relational_operator_0=equals&filter_0=%5B2010+TO+2019%5D&rpp=10&sort_by=score&order=desc&page=52
47. Lopez G. The US’s Covid-19 death toll is still among the worst in the world - Vox. Vox. 2021. Accessed May 14, 2024. https://www.vox.com/future-perfect/2021/1/11/22220827/covid-19-pandemic-coronavirus-usa-europe-canada-trump
48. Van Dorn A, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. The Lancet. 2020;395(10232):1243-1244.
49. Himmelstein DU, Woolhandler S. The U.S. Health Care System on the Eve of the Covid-19 Epidemic: A Summary of Recent Evidence on Its Impaired Performance. Int J Health Serv. 2020;50(4):408-414. doi:10.1177/0020731420937631
50. Ahlbach C, King T, Dzeng E. The COVID-19 Pandemic and Ethical Challenges Posed by Neoliberal Healthcare. J Gen Intern Med. 2021;36(1):205-206. doi:10.1007/s11606-020-06316-w
51. Peterson CL, Walker C. Universal health care and political economy, neoliberalism and effects of COVID ‐19: A view of systems and complexity. J Eval Clin Pract. 2022;28(2):338-340. doi:10.1111/jep.13631
52. Prince R, Kearns R, Craig D. Governmentality, discourse and space in the New Zealand health care system, 1991–2003. Health Place. 2006;12(3):253-266.
53. Bandyopadhyay G, Meltzer A. Let us unite against COVID-19–a New Zealand perspective. Ir J Psychol Med. 2020;37(3):218-221.
54. Henrickson M. Kiwis and COVID-19: The Aotearoa New Zealand Response to the Global Pandemic. Int J Community Soc Dev. 2020;2(2):121-133. doi:10.1177/2516602620932558
55. Delgado MS. Chile and the covid-19 pandemic: remembering social medicine in the context of the neoliberal crisis. História Ciênc Saúde-Manguinhos. 2021;29:269-276.
56. Bilal U, Alfaro T, Vives A. COVID-19 and the worsening of health inequities in Santiago, Chile. Int J Epidemiol. 2021;50(3):1038-1040.
57. Mena GE, Martinez PP, Mahmud AS, Marquet PA, Buckee CO, Santillana M. Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile. Science. 2021;372(6545):eabg5298. doi:10.1126/science.abg5298
58. Torres I, López-Cevallos D. In the name of COVID-19: legitimizing the exclusion of community participation in Ecuador’s health policy: Special call: Health Promotion Perspectives on the COVID-19 Pandemic. Health Promot Int. 2021;36(5):1324-1333.
59. López-Cevallos D, Chi C, Ortega F. Equity-based considerations for transforming the Ecuadorian health system. Rev Salud Pública. 2014;16(3):346-359.
60. Castañeda-Orjuela C, Gaitan LH, Diaz-Jimenez D, Cotes-Cantillo K, Garfield R. Maternal mortality in Colombia during the COVID-19 pandemic: time series and social inequities. BMJ Open. 2023;13(4):e064960.
61. Daniels JP. Colombians protest over inequities and health care. The Lancet. 2021;397(10293):2454.
62. Worldometer info. COVID - Coronavirus Statistics - Worldometer. Worldometer Coronavirus. 2024. Accessed May 19, 2024. https://www.worldometers.info/coronavirus/
63. Zanin M, Xiao C, Liang T, et al. The public health response to the COVID-19 outbreak in mainland China: a narrative review. J Thorac Dis. 2020;12(8):4434.
64. Martinez C. Karl Marx In Wuhan: How Chinese Socialism Is Defeating COVID-19. Int Crit Thought. 2020;10(2):311-322. doi:10.1080/21598282.2020.1779504
65. Lu Q, Cai Z, Chen B, Liu T. Social policy responses to the Covid-19 crisis in China in 2020. Int J Environ Res Public Health. 2020;17(16):5896.
66. Pan American Health Organization. Annual Report 2021. Guyana: Responding to COVID-19 and Preparing for the Future PAHO/GUY/22-0001. PAHO-WHO; 2022. Accessed May 27, 2024. https://iris.paho.org/handle/10665.2/56334
67. World Bank. World Bank Provides $7.5 Million to Support Guyana’s COVID-19 Response. WorldBank -Press release. November 25, 2020. Accessed May 27, 2024. https://www.worldbank.org/en/news/press-release/2020/11/25/world-bank-provides-75-million-to-support-guyanas-covid-19-response
68. Kabwama SN, Kiwanuka SN, Mapatano MA, et al. Private sector engagement in the COVID-19 response: experiences and lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda. Glob Health. 2022;18(1):60. doi:10.1186/s12992-022-00853-1
69. Paul E, Ndiaye Y, Sall FL, Fecher F, Porignon D. An assessment of the core capacities of the Senegalese health system to deliver Universal Health Coverage. Health Policy OPEN. 2020;1:100012.
70. Litewka SG, Heitman E. Latin American healthcare systems in times of pandemic. Dev World Bioeth. 2020;20(2):69-73. doi:10.1111/dewb.12262
71. Chen I, Chen Y, Tsai DFC. Response to COVID-19 Pandemic and Ethical Innovations in Taiwan. In: Kurihara C, Greco D, Dhai A, eds. Ethical Innovation for Global Health: Pandemic, Democracy and Ethics in Research. Springer Nature Singapore; 2023:57-67. doi:10.1007/978-981-99-6163-4_4
72. Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing. Jama. 2020;323(14):1341-1342.
73. Welfare NHIAM of H and. Taiwan Can Help - National Health Insurance’s Contribution in Combating COVID-19. National Health Insurance Administration Ministry of Health and Welfare. June 6, 2022. Accessed May 27, 2024. https://www.nhi.gov.tw/en/cp-436-d7330-47-2.html
74. Camargo Plazas P. Understanding the space of nursing practice in Colombia: A critical reflection on the effects of health system reform. Nursing Inquiry. 2018 Jul;25(3):e12242.
2. Almeida A. The trade-off between health system resiliency and efficiency: evidence from COVID-19 in European regions. Eur J Health Econ. 2024;25(1):31-47. doi:10.1007/s10198-023-01567-w
3. Maani N, Galea S. COVID-19 and underinvestment in the public health infrastructure of the United States. Milbank Q. 2020;98(2):250.
4. David Williams O, Yung KC, Grépin KA. The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems. Glob Public Health. 2021;16(8-9):1320-1333. doi:10.1080/17441692.2021.1874470
5. Vallier K. Neoliberalism. Published online 2021. Accessed March 30, 2024. https://plato.stanford.edu/entries/neoliberalism/?ref=amonle.com
6. Evans P, Sewell WH. The neoliberal era: Ideology, policy, and social effects. Soc Resil Neoliberal Era. Published online 2013:35-68.
7. McGregor S. Neoliberalism and health care. Int J Consum Stud. 2001;25(2):82-89.
8. Lasswell HD. The political science of science: An inquiry into the possible reconciliation of mastery and freedom. Am Polit Sci Rev. 1956;50(4):961-979.
9. Brewer GD, DeLeon P. The Foundations of Policy Analysis. Brooks/Cole Publishing Company; 1983. https://books.google.com.eg/books?id=Vq7uAAAAMAAJ
10. Adelle C, Jordan A, Turnpenny J. Policy making. In: Environmental Policy in the EU. Routledge; 2012:235-252. Accessed April 2, 2024. https://www.taylorfrancis.com/chapters/edit/10.4324/9780203109823-25/policy-making-camilla-adelle-andrew-jordan-john-turnpenny
11. Collier D. The comparative method. Polit Sci State Discip II Ada W Finifter Ed Am Polit Sci Assoc. Published online 1993. Accessed April 14, 2024. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1540884
12. Stafford A. Comparative analysis within political science. E-Int Relat. 2013;1(4).
13. Levy FD. Chile: an economy in transition. World Bank Ctry Study USA. Published online 1983.
14. Gideon J. Counting the cost of privatised provision: Women, rights and neoliberal health reforms in Chile. IDS Bull. 2008;39(6):75-82. doi:10.1111/j.1759-5436.2008.tb00514.x
15. Rotarou ES, Sakellariou D. Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile. Health Policy. 2017;121(5):495-503.
16. Taylor M. The reformulation of social policy in Chile, 1973-2001: Questioning a neoliberal model. Glob Soc Policy. 2003;3(1):21-44. doi:10.1177/1468018103003001009
17. Tsai TC, Jl J. Neoliberalism and its discontents: Impact of health reforms in Chile. Harv Int Rev. 2009;31(2):32-36.
18. López-Cevallos DF, Chi C. Health care utilization in Ecuador: a multilevel analysis of socio-economic determinants and inequality issues. Health Policy Plan. 2010;25(3):209-218.
19. De Paepe P, Tapia RE, Santacruz EA, Unger JP. Ecuador’s silent health reform. Int J Health Serv. 2012;42(2):219-233. doi:10.2190/HS.42.2.e
20. Friederic K, Burke BJ. La Revolución Ciudadana and social medicine: Undermining community in the state provision of health care in Ecuador. Glob Public Health. 2019;14(6-7):884-898. doi:10.1080/17441692.2018.1481219
21. Mahmood Q, Muntaner C. Theoretical underpinnings of state institutionalisation of inclusion and struggles in collective health in Latin America. Glob Public Health. 2019;14(6-7):863-874. doi:10.1080/17441692.2018.1455886
22. Muntaner C, Salazar RMG, Rueda S, Armada F. Challenging the neoliberal trend: The Venezuelan health care reform alternative. Can J Public Health. 2006;97(6):1-19.
23. Misir P. Health care in guyana. Soc Med. 2015;9(1):36-47.
24. Seoane‐Vazquez E, Rodriguez‐Monguio R. Access to essential drugs in Guyana: a public health challenge. Int J Health Plann Manage. 2010;25(1):2-16. doi:10.1002/hpm.949
25. Walker A. Narrating health and scarcity: Guyanese healthcare workers, development reformers, and sacrifice as solution from socialist to neoliberal governance. Soc Sci Med. 2017;187:225-232.
26. Barnett R, Barnett P. Back to the Future? Reflections on past reforms and future prospects for health services in New Zealand. GeoJournal. 2004;59(2):137-147. doi:10.1023/B:GEJO.0000019972.22425.8d
27. Brown H, Bryder L. Universal healthcare for all? Māori health inequalities in Aotearoa New Zealand, 1975–2000. Soc Sci Med. 2023;319. doi:10.1016/j.socscimed.2022.115315
28. Zhang W, Navarro V. Why hasn’t China’s high-profile health reform (2003-2012) delivered? An analysis of its neoliberal roots. Crit Soc Policy. 2014;34(2):175-198. doi:10.1177/0261018313514805
29. Duckett J, Langer AI. Populism versus Neoliberalism: Diversity and Ideology in the Chinese Media’s Narratives of Health Care Reform. Mod China. 2013;39(6):653-680. doi:10.1177/0097700413492602
30. Epperson B. Challenging narratives to neoliberalism in media representations of American health reform: Lessons from the United States. In: Neoliberal Contentions: Diagnosing the Present. ; 2022:133-155. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85145427868&partnerID=40&md5=c0c6e2cb81017a46e872889ca559d896
31. Waitzkin H, Hellander I. The History and Future of Neoliberal Health Reform: Obamacare and Its Predecessors. Int J Health Serv. 2016;46(4):747-766. doi:10.1177/0020731416661645
32. Foley EE. The anti-politics of health reform: Household power relations and child health in rural Senegal. Anthropol Med. 2009;16(1):61-71. doi:10.1080/13648470802426243
33. Chen C fen, Fu T hsi. Policies and transformation of long-term care system in Taiwan. Ann Geriatr Med Res. 2020;24(3):187.
34. Lee C, Chen MS. Rescuing Public Health From the Global Capitalist Regime: The Public Health Liberation Movement in Taiwan. Am Behav Sci. 2024;68(3):322-337. doi:10.1177/00027642221134845
35. Tsai MC. Dependency, the state and class in the neoliberal transition of Taiwan. Third World Q. 2001;22(3):359-379. doi:10.1080/01436590120061651
36. Mudge SL. What is neo-liberalism? Socio-Econ Rev. 2008;6(4):703-731.
37. Lu JFR, Chiang TL. Evolution of Taiwan’s health care system. Health Econ Policy Law. 2011;6(1):85-107.
38. Tsung-Mei Cheng. Taiwan’s health care system: The next 20 years. Brookings. May 14, 2015. Accessed April 30, 2024. https://www.brookings.edu/articles/taiwans-health-care-system-the-next-20-years/
39. Sparke M, Williams OD. Neoliberal disease: COVID-19, co-pathogenesis and global health insecurities. Environ Plan Econ Space. 2022;54(1):15-32. doi:10.1177/0308518X211048905
40. Abu El Kheir-Mataria W, El-Fawal H, Chun S. Global health governance performance during Covid-19, what needs to be changed? a delphi survey study. Glob Health. 2023;19(1):1-13.
41. Jung AS, Haldane V, Neill R, et al. National responses to covid-19: drivers, complexities, and uncertainties in the first year of the pandemic. bmj. 2021;375. Accessed May 14, 2024. https://www.bmj.com/content/375/bmj-2021-068954.abstract
42. Chua AQ, Tan MMJ, Verma M, et al. Health system resilience in managing the COVID-19 pandemic: lessons from Singapore. BMJ Glob Health. 2020;5(9):e003317.
43. Mahendradhata Y, Andayani NLPE, Hasri ET, et al. The capacity of the Indonesian healthcare system to respond to COVID-19. Front Public Health. 2021;9:649819.
44. Bush RW. Reducing waste in US health care systems. Jama. 2007;297(8):871-874.
45. Relman A. Why the US healthcare system is failing, and what might rescue it. BMJ. 2012;344. Accessed May 20, 2024. https://www.bmj.com/content/344/bmj.e3052.full
46. Rice T, Rosenau P, Unruh LY, et al. United States of America: health system review. Published online 2013. Accessed May 20, 2024. https://apps.who.int/iris/handle/10665/330305?search-result=true&query=¤t-scope=10665%2F107132&filtertype_0=dateIssued&filter_relational_operator_0=equals&filter_0=%5B2010+TO+2019%5D&rpp=10&sort_by=score&order=desc&page=52
47. Lopez G. The US’s Covid-19 death toll is still among the worst in the world - Vox. Vox. 2021. Accessed May 14, 2024. https://www.vox.com/future-perfect/2021/1/11/22220827/covid-19-pandemic-coronavirus-usa-europe-canada-trump
48. Van Dorn A, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. The Lancet. 2020;395(10232):1243-1244.
49. Himmelstein DU, Woolhandler S. The U.S. Health Care System on the Eve of the Covid-19 Epidemic: A Summary of Recent Evidence on Its Impaired Performance. Int J Health Serv. 2020;50(4):408-414. doi:10.1177/0020731420937631
50. Ahlbach C, King T, Dzeng E. The COVID-19 Pandemic and Ethical Challenges Posed by Neoliberal Healthcare. J Gen Intern Med. 2021;36(1):205-206. doi:10.1007/s11606-020-06316-w
51. Peterson CL, Walker C. Universal health care and political economy, neoliberalism and effects of COVID ‐19: A view of systems and complexity. J Eval Clin Pract. 2022;28(2):338-340. doi:10.1111/jep.13631
52. Prince R, Kearns R, Craig D. Governmentality, discourse and space in the New Zealand health care system, 1991–2003. Health Place. 2006;12(3):253-266.
53. Bandyopadhyay G, Meltzer A. Let us unite against COVID-19–a New Zealand perspective. Ir J Psychol Med. 2020;37(3):218-221.
54. Henrickson M. Kiwis and COVID-19: The Aotearoa New Zealand Response to the Global Pandemic. Int J Community Soc Dev. 2020;2(2):121-133. doi:10.1177/2516602620932558
55. Delgado MS. Chile and the covid-19 pandemic: remembering social medicine in the context of the neoliberal crisis. História Ciênc Saúde-Manguinhos. 2021;29:269-276.
56. Bilal U, Alfaro T, Vives A. COVID-19 and the worsening of health inequities in Santiago, Chile. Int J Epidemiol. 2021;50(3):1038-1040.
57. Mena GE, Martinez PP, Mahmud AS, Marquet PA, Buckee CO, Santillana M. Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile. Science. 2021;372(6545):eabg5298. doi:10.1126/science.abg5298
58. Torres I, López-Cevallos D. In the name of COVID-19: legitimizing the exclusion of community participation in Ecuador’s health policy: Special call: Health Promotion Perspectives on the COVID-19 Pandemic. Health Promot Int. 2021;36(5):1324-1333.
59. López-Cevallos D, Chi C, Ortega F. Equity-based considerations for transforming the Ecuadorian health system. Rev Salud Pública. 2014;16(3):346-359.
60. Castañeda-Orjuela C, Gaitan LH, Diaz-Jimenez D, Cotes-Cantillo K, Garfield R. Maternal mortality in Colombia during the COVID-19 pandemic: time series and social inequities. BMJ Open. 2023;13(4):e064960.
61. Daniels JP. Colombians protest over inequities and health care. The Lancet. 2021;397(10293):2454.
62. Worldometer info. COVID - Coronavirus Statistics - Worldometer. Worldometer Coronavirus. 2024. Accessed May 19, 2024. https://www.worldometers.info/coronavirus/
63. Zanin M, Xiao C, Liang T, et al. The public health response to the COVID-19 outbreak in mainland China: a narrative review. J Thorac Dis. 2020;12(8):4434.
64. Martinez C. Karl Marx In Wuhan: How Chinese Socialism Is Defeating COVID-19. Int Crit Thought. 2020;10(2):311-322. doi:10.1080/21598282.2020.1779504
65. Lu Q, Cai Z, Chen B, Liu T. Social policy responses to the Covid-19 crisis in China in 2020. Int J Environ Res Public Health. 2020;17(16):5896.
66. Pan American Health Organization. Annual Report 2021. Guyana: Responding to COVID-19 and Preparing for the Future PAHO/GUY/22-0001. PAHO-WHO; 2022. Accessed May 27, 2024. https://iris.paho.org/handle/10665.2/56334
67. World Bank. World Bank Provides $7.5 Million to Support Guyana’s COVID-19 Response. WorldBank -Press release. November 25, 2020. Accessed May 27, 2024. https://www.worldbank.org/en/news/press-release/2020/11/25/world-bank-provides-75-million-to-support-guyanas-covid-19-response
68. Kabwama SN, Kiwanuka SN, Mapatano MA, et al. Private sector engagement in the COVID-19 response: experiences and lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda. Glob Health. 2022;18(1):60. doi:10.1186/s12992-022-00853-1
69. Paul E, Ndiaye Y, Sall FL, Fecher F, Porignon D. An assessment of the core capacities of the Senegalese health system to deliver Universal Health Coverage. Health Policy OPEN. 2020;1:100012.
70. Litewka SG, Heitman E. Latin American healthcare systems in times of pandemic. Dev World Bioeth. 2020;20(2):69-73. doi:10.1111/dewb.12262
71. Chen I, Chen Y, Tsai DFC. Response to COVID-19 Pandemic and Ethical Innovations in Taiwan. In: Kurihara C, Greco D, Dhai A, eds. Ethical Innovation for Global Health: Pandemic, Democracy and Ethics in Research. Springer Nature Singapore; 2023:57-67. doi:10.1007/978-981-99-6163-4_4
72. Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing. Jama. 2020;323(14):1341-1342.
73. Welfare NHIAM of H and. Taiwan Can Help - National Health Insurance’s Contribution in Combating COVID-19. National Health Insurance Administration Ministry of Health and Welfare. June 6, 2022. Accessed May 27, 2024. https://www.nhi.gov.tw/en/cp-436-d7330-47-2.html
74. Camargo Plazas P. Understanding the space of nursing practice in Colombia: A critical reflection on the effects of health system reform. Nursing Inquiry. 2018 Jul;25(3):e12242.