Since the 1990s, criticism has mounted regarding the IMF's narrow construction of a 'one size fits all' economic policy. "Policies of privatization and deregulation may work better in developed countries in the West, but, maybe more difficult to implement in the developing world" (Pettinger 2009). There is also alarm that the IMF is excessively directive when extending loans to nations -- for example, mandating user fees for health care, an important issue in the current struggle for Jamaica to borrow funds from the IMF. Jamaica charges no user fees in its system of nationalized care, although the IMF argues that charging money, according to classical economic theory, enables more effective use of scarce healthcare resources. Yet "there is compelling evidence of a link between user fees and poverty. In a study that shows the 'poverty impact' of out-of-pocket payments (OOP), 78 million people in 11 low/middle income countries in Asia...
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