Since the early 1990s, institutions such as the World Bank and the International
Monetary Fund have required state-owned hospitals and clinics in Third World
countries to be privatized before loans are considered. Many times those
formerly state-owned and -run hospitals were purchased by U.S. and European
insurance companies that then introduced U.S. models of managed care, even
though the history of healthcare in those countries was vastly different from
the systems that had developed in the United States.