Dissociation of Value Extraction: The Financialization of Solidarity-Based German Ambulatory Healthcare [Dissoziation von Wertextraktion: Die Finanzialisierung aus dem solidarischen deutschen ambulanten Gesundheitssystem]

Bůžek, Richard

Abstract

This paper explores why the financialization of physician practices by private equity (PE) and the resulting value extraction from Germany’s solidarity-based healthcare system go largely unexamined in healthcare studies and regulation, despite contestation by medical associations. It contributes to feminist political-economic critiques of finance’s impact on social reproduction, employing the perspectives of economization and dissociation from heterodox economic geography. This framework reveals how a solidarity-based health economy has historically aligned with neoclassical logics and how value extraction falls from view in this framing. Drawing on analyses of corporate spatial structures of PE-led healthcare chains, as well as narrative patterns from expert interviews and a text corpus on the disputed financialized restructuring of ambulatory healthcare, the paper identifies two dissociations that obscure value extraction and hinder effective regulatory oversight. First, the discursive framing of the ambulatory health economy through a neoclassical (health) economics lens makes value extraction seem implausible or invisible. Second, the opaque spatial ownership structures of PE-led healthcare chains prevent independent, evidence-based monitoring of these financialized healthcare providers. Therefore, the paper advocates for incorporating heterodox perspectives in health policy advising to rethink and foster definancialized investment and ownership models for a sustainable and solidarity-based future health economy.