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449Privatization
and COVID-19: A Deadly Combination for Nursing Homes
services, but also from a commitment to shared responsibility, demo-
cratic decision-making, and the idea that the public sector operates
according to a logic of service to all.
The most obvious form of privatization is the move to for-profitÂ
delivery of all or part of a health care service. Canada has a history
of private, non-profit delivery of many services, but the consider-
able expansion of for-profit delivery for publicly funded services is
a relatively new development. This shift has been promoted on the
assumption that for-profit provision is more efficient and provides
better quality, primarily as a result of competition, and can provide
the necessary capital without requiring public investment. These
same assumptions provide the basis for privatization through the pro-
motion of for-profit managerial practices within the not-for-profit and
public services that remain.
The shift of payment from the public to families and individuals is
less obvious. Services are quietly removed from public coverage and
charges raised. Care deficits that remain push Canadians to seek pri-
vately paid options. As Macarov explains, privatization âis sometimes
attained not by outright sales but by deliberately allowing services to
run down, by erecting barriers to access, by withholding information
and by making receiving benefits so difficult and demeaning that the
public has little alternative but to turn to the private sector.â2
It is not only the costs that are shifted, but also the work of provid-
ing care when public options are not available or at least available in
forms that provide adequate care. Over the last three decades there has
been a growing emphasis on what has been called responsibilization,3 a
transfer of responsibility for health and care to individuals and some-
times their families, often ironically under the guise of âchoice.â
Along with these processes comes the privatization of decision-
making. For-profit corporations are allowed a considerable degree of
Privatization: Women and Health Care Reform in Canada (Toronto: University of
Toronto Press Higher Education, Broadview Press, 2001); Hugh Armstrong,
Pat Armstrong & M Patricia Connelly, âThe Many Forms of Privatizationâ (1997)
53:1 Studies in Political Economy 3.
2. David Macarov, What the Market Does to People: Privatization, Globalization andÂ
Poverty (Atlanta: Clarity Press, 2003) at 7.
3. See, for example, Mike Dent, âPatient Choice and Medicine in Health Care:
Responsibilization, Governance and Proto-Professionalizationâ (2006) 8:3 Public
Management Review 449, DOI: <10.1080/14719030600853360>; Gary C Gray,
âThe Responsibilization Strategy of Health and Safety: Neo-liberalism and the
Reconfiguration of Individual Responsibility for Riskâ (2009) 49:3 British Journal
of Criminology 326.
VULNERABLE
The Law, Policy and Ethics of COVID-19
- Titel
- VULNERABLE
- Untertitel
- The Law, Policy and Ethics of COVID-19
- Autoren
- Vanessa MacDonnell
- Jane Philpott
- Sophie Thériault
- Sridhar Venkatapuram
- Verlag
- Ottawa Press
- Datum
- 2020
- Sprache
- englisch
- Lizenz
- CC BY-NC-ND 4.0
- ISBN
- 9780776636429
- Abmessungen
- 15.2 x 22.8 cm
- Seiten
- 648
- Kategorien
- Coronavirus
- International