Commodification of Health Under Neoliberalism: A Comparison of the Israeli and the Spanish Cases

The present paper compares processes of privatization in health care in Spain and Israel, focusing mainly on forms of public/private mix, to evaluate concretely the 'variegated' character of neo-liberalization processes. Sociological thinking on global/local interactions contribute to understand privatization processes as simultaneously patterned by global neo-liberal assumptions and conditioning, therefore interconnected; and locally specific, modulated by the institutional, socio-historical and political characteristics of the different countries.

Privatization of health care takes three main forms, privatization of financing, privatization of ownership and the "enterprization" of the public system, blurring the boundaries between public and private. Both in Spain and Israel this last dimension is the central form of privatization and represents the main threat to the public health care system.

This paper analyzes the concrete institutional forms of private/public mix in both countries. In Spain, out-sourcing of services, private-finance initiatives and the "Alcira model"; all maintain relatively clear boundaries between the private and the public sectors. In Israel, forms of public/private mix have been forms have blurred the boundaries between the public and the private system: private insurance sold by public sick funds, private for-profit hospitals owned by the public non-profit sick funds and public hospitals selling private services.

The comparison of the processes of privatization in health care in Spain and Israel, shows the variegated character of neoliberalization processes, the ways in which the global transition to a neo-liberal model does not result in convergence but in the "systemic production of geoinstitutional differentiation" (Brenner, Peck and Theodor 2010). The comparison shows the active role played by the local context in shaping the specific forms of a process of privatization originated in neo-liberal global tendencies. The paper illuminates the role of national and regional state apparatuses, civil society organizations and professional culture as initiators and supporters of privatization.