Benjamin M. Hunter

Background: GP practices in Scotland are changing with the emergence of megapractices. We aimed to update analyses of GP practice sizes in Scotland, and to begin the development of a typology of GP practices. Methods: Four methods were employed: 1. Analyses of routinely published data on GP practice sizes and listed GPs to identify and quantify megapractices; 2. Qualitative interviews; 3. Creation of commercial profiles; 4. Derivation of a GP practice typology. Results: Most Scottish practices have less than 9,000 patients, but five megapractices with over 30,000 patients were identified. One had grown by over 18,000 patients in two years to almost 120,000 patients, with the next largest at almost 73,000 patients. Megapractices did not engage with interviews, but commercial profiling revealed an array of complex legal and financial arrangements for several of them. We suggest that the key parameters for describing practices should focus on: ownership, legal status and motives; the extent of service provision by doctors or Allied Health Professionals (AHPs); and practice list size. We tentatively propose four common practice types in Scotland: traditional practices, megapractices, social enterprise practices, and direct NHS provision, recognising substantial diversity amongst megapractices. Implications: Policymakers should carefully consider the risks of the current drift in approach to GP provisioning. Evaluation of the impacts of new service models on healthcare access, health outcomes and inequalities is urgently needed.

Privatisation of previously public industries and services is part of the ideological shift associated with the global neoliberal turn of the past 40 years. This article examines such a change within the healthcare system in China: specifically, the formation and development of a private hospital sector, which by 2015 surpassed the number of public hospitals for the first time. We draw on documentary and interview-based data, both English-language and Chinese-language to examine the privatisation process in this setting. We show that while the re-establishment of the private hospital sector in China followed a relatively well-trodden path wherein government policy shifts to sanction private-for-profit sector growth in the social sectors, several context-specific features reflect China’s contemporary state capitalism as the Chinese state has chosen to actively direct infrastructure formation in the private hospital sector and finance it through state-owned enterprises and investments. Our analysis demonstrates the importance of approaches to studying social policy that build nuanced understanding of public-private relations and state restructuring, and how these materialise in different settings.

Background: Contemporary conditions require detailed study of internationalisation. This article offers a novel perspective on processes of internationalisation in healthcare, adapting an approach from higher education studies and enhancing it with insights from sociological scholarship on moral economies. The article asks how institutions and individuals respond to the globalising healthcare environment, and what this reveals about normative questions that govern healthcare provisioning in national contexts. This is pursued using qualitative data from a study on international commercial services in the English National Health Service (NHS). Results: The findings of the research demonstrate how the UK government has sought to build political consensus around specific (commodified) forms of internationalisation in a context of fiscal austerity and xenophobia surrounding the provision of public services. The English NHS has been politically re-imagined as world-leading and of interest as an export industry. Study findings show this stance is premised normatively on processes of subsidy between two apparently distinct spheres – from international (private) to national (public) – but that in practice the distinction is hazy and subsidy at times indirect, routed to individual staff members or to commercial teams. The ascendancy of this as a prevailing, politically legitimate form of internationalisation for the English NHS contrasts sharply with non-commodified alternatives decried as ‘health tourism’. Conclusions: The internationalisation framework presented in this article offers a platform for future research that can shed light on the contexts, visions, policies and contestations the emerge as healthcare institutions respond to processes of globalisation. It will be important to avoid uncritical approaches to research and policy by examining not just what forms of internationalisation find favour, and their basis in geographical and racialised hierarchies, but also how approaches to healthcare internationalisation impact inequalities within and between nations.

The incursion of the financial sector into contemporary politics, economies and societies has been noted, yet financialisation remains under‐explored in the sociological study of healthcare. Using the case of Maharashtra, India, and a qualitative research approach combining policy documents, witness seminars and in‐depth interviews, we offer an account of how financialisation has been facilitated and enacted in this sector. We analyse the restructuring of a healthcare system in favour of corporate chains and calculative logics, with concomitant changes including closure and takeover of smaller hospitals and re‐modelling of not‐for‐profit hospitals along corporate lines. We highlight ways in which such financialisation of healthcare, and its sidelining of health needs, has significance for care processes, professional dynamics, access to care and the parameters of regulatory systems.

Background High-income countries increasingly look to the international recruitment of health workers to address domestic shortages, especially from low-income and middle-income countries. We adapt conceptual frameworks from migration studies to examine the networked and commercialised nature of the Indian market for nurse migration to the UK. Methods We draw on data from 27 expert interviews conducted with migration intermediaries, healthcare providers and policymakers in India and the UK. Findings India–UK nurse migration occurs within a complex and evolving market encompassing ways to educate, train and recruit nursing candidates. For-profit actors shape the international orientation of nursing curricula, broker on-the-job training and offer language, exam and specialised clinical training. Rather than merely facilitate travel, these brokers produce both generic, emigratory nurses as well as more customised nurses ready to meet specific shortages in the UK. Discussion The dialectic of producing emigratory and customised nurses is similar to that seen in the Post-Fordist manufacturing model characterised by flexible specialisation and a networked structure. As the commodity in this case are people attempting to improve their position in life, these markets require attention from health policy makers. Nurse production regimes based on international market opportunities are liable to change, subjecting nurses to the risk of having trained for a market that can no longer accommodate them. The commercial nature of activities further entrenches existing socioeconomic inequalities in the Indian nurse force. Negative repercussions for the source healthcare system can be anticipated as highly qualified, specialised nurses leave to work in healthcare systems abroad.

Handcrafted and deep learning (DL) radiomics are popular techniques used to develop computed tomography (CT) imaging-based artificial intelligence models for COVID-19 research. However, contrast heterogeneity from real-world datasets may impair model performance. Contrast-homogenous datasets present a potential solution. We developed a 3D patch-based cycle-consistent generative adversarial network (cycle-GAN) to synthesize non-contrast images from contrast CTs, as a data homogenization tool. We used a multi-centre dataset of 2078 scans from 1,650 patients with COVID-19. Few studies have previously evaluated GAN-generated images with handcrafted radiomics, DL and human assessment tasks. We evaluated the performance of our cycle-GAN with these three approaches. In a modified Turing-test, human experts identified synthetic vs acquired images, with a false positive rate of 67% and Fleiss’ Kappa 0.06, attesting to the photorealism of the synthetic images. However, on testing performance of machine learning classifiers with radiomic features, performance decreased with use of synthetic images. Marked percentage difference was noted in feature values between pre- and post-GAN non-contrast images. With DL classification, deterioration in performance was observed with synthetic images. Our results show that whilst GANs can produce images sufficient to pass human assessment, caution is advised before GAN-synthesized images are used in medical imaging applications.

This article examines an attempt to reconstitute global development governance in a context of growing influence for private finance. We focus on the World Bank’s Human Capital Project (HCP) and Human Capital Index (HCI), which have stated aims of promoting economic growth and accelerating progress towards achievement of the Sustainable Development Goals. Informed by a review of publicly available World Bank materials, we argue that, through its HCP and HCI, the World Bank is responding to its own institutional sidelining in development financing and governance with a strategy of reintermediation. Its leaders have pursued a system of governance in which the World Bank creates and instrumentalises knowledge on human capital – an asset to be accumulated through judicious investments in markets for self-betterment. Through its HCI the World Bank has expanded its global benchmarking practices, encompassing new domains and quantified predictions of future productivity, in the hope of shaping domestic policy processes. Its leaders propose to use HCI scores to signal risk to investors and political leaders, triggering political shocks that will spur policy reform. Crucially, these efforts seek to reassert the World Bank’s epistemic authority and financing clout as the influence of its own lending wanes. Supplemental data for this article is available online at https://doi.org/10.1080/01436597.2021.1953980 .