ABSTRACT
The organization of property rights, constituting one of the fundamental tenets emerging from economic theory, has long pivoted between private property rights and public property rights, depending on which theory is ascendant. Healthcare systems are inextricably tied to the ways in which property is held. Thus, with the contemporary dominance of global neoliberal policy prescriptions that rest on private property, the governance of healthcare systems has followed suit. Given the ideological, political, and economic contestations between private and public systems, this chapter explores a third way of ownership and governance in common property regimes. Specifically, it asks: could the commons bridge over the divides and close the gaps inherent in modern healthcare systems? The existence of commons-based ownership and governance systems predates both public and private property regimes. Yet, while overshadowed, the chapter demonstrates that common property regimes still form the basis of many natural resource management systems even today, particularly among indigenous peoples. It reflects on how the political economy of these systems rests on the concept of polycentricity – specifically, polycentric governance, in which a system has multiple, formally independent centers of decision-making. Such governance, characterized by commons-based systems, embeds features that safeguard equitable access and sustainable use of resources. In turn, the chapter analyses the logic and operation of a commons-based health system, through discerning its key features in Malaysia’s indigenous population, the Orang Asli. It proposes the commons as an alternative way to organize health services that, when complemented with public and private health systems, can provide vital pathways to address persistent health inequities and improve the well-being of indigenous peoples.
