Banking on Health: Variable Approaches and Contingent Outcomes
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The final chapter synthesizes the information gleaned from quantitative, regional analyses, which do not indicate a downward effect on health expenditures by the World Bank in Latin America, and from qualitative, country case analyses, which reveal that the World Bank operates differently across countries, in interaction with national contexts. Health includes not just financial and monetary management but also stands at the core of citizen–state contracts, welfare politics, and national and individual identities, and is therefore a more complex field of analysis. As such, our understanding of what neoliberalism in health means deserves important attention. All countries are looking for cost cutting, efficiency-enhancing measures with burgeoning health care costs and aging populations. The World Bank’s work in health utilizes what many consider neoliberal tools and instruments (e.g., targeting and decentralization) but sometimes in the interest of universalism and equity. I argue that state capacity and autonomy shape the World Bank’s interest in and the substance of its involvement in health across countries, sometimes in surprising ways. The chapter concludes by highlighting the book’s contribution to our empirical, conceptual, and theoretical understandings of welfare state development, neoliberalism in health, the World Bank and global governance, and health sector reform.