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Unmanageable CareAn Ethnography of Health Care Privatization in Puerto Rico$
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Jessica M. Mulligan

Print publication date: 2014

Print ISBN-13: 9780814724910

Published to NYU Press Scholarship Online: March 2016

DOI: 10.18574/nyu/9780814724910.001.0001

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A History of Reform

A History of Reform

Colonialism, Public Health, and Privatized Care

Chapter:
(p.31) 1 A History of Reform
Source:
Unmanageable Care
Author(s):

Jessica M. Mulligan

Publisher:
NYU Press
DOI:10.18574/nyu/9780814724910.003.0002

This chapter retraces the 100-year history of reforms to the health system of Puerto Rico, beginning with the U.S. occupation in 1898. It highlights the shifting organizing principles of health planners and regulators, which include sanitation and controlling communicable diseases during the first half of the 20th century, public health goals and ensuring universal access to care during the mid-century, and efficiency and the free market beginning in the 1990s. The U.S. invasion of the islands militarized medicine on the island. Initially, health was a military affair insofar as, through public sanitation and venereal disease campaigns, Puerto Rico was to be made safe for American soldiers and the “civilizing” colonial project. The chapter sheds light on how colonialism has consistently shaped the structure and goals of the nation's health system. In addition, it uses ethnographic interviews to illustrate some of the contradictory assessments of privatization.

Keywords:   health system reforms, Puerto Rico, health planners, 1898, colonialism, medicine, communicable diseases, public sanitation, venereal disease, privatization

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