The Global South political economy of health financing and spending landscape - history and presence

The Global South nations and their statehoods have presented a driving force of economic and social development through most of the written history of humankind. China and India have been traditionally accounted as the economic powerhouses of the past. In recent decades, we have witnessed reestablishment of the traditional world economic structure as per Agnus Maddison Project data. These profound changes have led to accelerated real GDP growth across many LMICs and emerging countries of the Global South. This evolution had a profound impact on an evolving health financing landscape. This review revealed hidden patterns and explained the driving forces behind the political economy of health spending in these vast world regions. The medical device and pharmaceutical industry play a crucial role in addressing the unmet medical needs of rising middle class citizens across Asia, Latin America, and Africa. Domestic manufacturing has only been partially meeting this ever rising demand for medical services and medicines. The rest was complemented by the participation of multinational pharmaceutical industry, whose focus on investment into East Asia and ASEAN nations remains part of long-term market access strategies. Understanding of the past remains essential for the development of successful health strategies for the present. Political economy has been driving the evolution of health financing landscape since the establishment of early modern health systems in these countries. Fiscal gaps these governments face in diverse ways might be partially overcome with the spreading of cost-effectiveness based decision-making and health technology assessment capacities. The considerable remaining challenges ranging from insufficient reimbursement rates, large out-of-pocket spending, and lengthy lag in the introduction of cutting-edge technologies such as monoclonal antibodies, biosimilars, or targeted oncology agents, might be partially resolved only in the long run.

Material conditions and ideas in global history

Since the rise of a "scientific" historiography in the nineteenth century, the role of ideas in history versus that of material forces has been a key philosophical problem. Thomas Piketty's Capital and Ideology (2019), read as a work of global history, offers a provocative rehearsal of this question. On the one hand, the book is an attempt to provide a narrative historical frame for the hard data of the World Inequality Database. On the other, paradoxically, it offers a defiant conclusion that ideology is, or at least could be, the key driver in social and institutional change towards universal progress. St Simon, Comte and Spencer have found their twenty-first century heir. How can we historicize Piketty's impetus, both understanding its provenance and making sense of its limitations? One key issue is its roots in the traditions of National Accounts, which leads to an approach to the global which is stresses comparison over connection, and to an uncritical reproduction of the portrait of an egalitarian non-capitalist Twentieth century painted by Kuznets during the Cold War. Another is its presentism, with the historical argument driven by an attempt to understand the c.1980-2020 conjuncture and its alternatives, and a connected overdependence on the support of a few historians. A third, a consequence in part of the inequalities between the quality of data we have for different parts of the world, and of Piketty's provenance and imagined audience, is a Eurocentric, even Gallocentric approach. A fourth is a very French republican refusal to address how class is complicated by identities of race and nation so that neither egalitarian policies nor ideologies provide remedies for the populist politics of right. None of these criticisms are in contradiction with our view that Capital and Ideology is a work of social theory of world historical importance.

The changing geography of social mobility in the United States

New evidence shows that intergenerational social mobility-the rate at which children born into poverty climb the income ladder-varies considerably across the United States. Is this current geography of opportunity something new or does it reflect a continuation of long-term trends? We answer this question by constructing data on the levels and determinants of social mobility across American regions over the 20th century. We find that the changing geography of opportunity-generating economic activity restructures the landscape of intergenerational mobility, but factors associated with specific regional structures of interpersonal and racial inequality that have "deep roots" generate persistence. This is evident in the sharp decline in social mobility in the Midwest as economic activity has shifted away from it and the consistently low levels of opportunity in the South even as economic activity has shifted toward it. We conclude that the long-term geography of social mobility can be understood through the deep roots and changing economic fortunes of places.

Organization and Finance of China's Health Sector: Historical Antecedents for Macroeconomic Structural Adjustment

China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP). Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China’s shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China’s evolution, adding another layer of complexity to policy.