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Health service delivery is being restructured in many different ways in both the industrialized and developing countries. This process is set to accelerate as a result of diverse factors including fiscal pressure, privatization and the renegotiation of the WTO General Agreement on Trade in Services (GATS), with important implications for access and equity in the healthcare field. The contributors to this volume review the rapidly changing context of debates about financing health care and its relationship to globalization and privatization and examine the mechanisms and institutional processes involved. They explore four very different country experiences: the USA, where the creed of market competition and managed care in the health sector is most advanced; Western Europe, where reforms aimed at market competition and freedom of choice are taking place; developing countries, where the role of the state in healthcare delivery is being dramatically reduced; and Cuba, which shows what political commitment to public health can still achieve despite scarce resources.
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