This paper examines some of the implications of the process of privatisation of a
national healthcare system for the delivery, organisation and, ultimately, the outcome
of services. Through a case study of obstetric care in Chile, authors illuminate
the relationships between the macro-level of political decisions, the meso-level
of the organisations through which government reforms were enacted, and the micro-level
of clinical practice. Authors show that, for a significant proportion of Chilean
women seeking maternity care, privatisation has led to expanded access and to ostensibly
highly-personalised relationships with specialists. However, because of the fragmentation
of maternity services, the altered work patterns for obstetricians occasioned by
changes in healthcare financing and the relatively weak market position of most obstetricians,
this personalised care is dependent on highly technologised obstetric practices.
By examining the specific organisational arrangements under which private maternity
care is conducted in Chile authors shed light on the connection between privately-funded
maternity care and high caesarean section rates in this setting.