What is the link between right to health and health financing?
To realize the right to health, individuals should be able to access health-related components such as quality-assured treatment, health technology and preventive care without restriction. Many people across the world do not receive the care they need due to structural and personal financing challenges. In developed countries these could include excessive costs of medicine, limited insurance coverage or overburdened public health systems. In developing countries, heavy out-of-pocket spending on healthcare drives individuals and households to compromise on basic health needs, or other opportunities like attaining skills or generating income.
Financing challenges undermine the right to health because individuals cannot access the tools, services and guidance to maintain or improve their well-being. The World Bank states that strong primary care addresses 90% of all health needs.[1] However, according to the World Health Organization, almost half of the world’s population cannot access primary care.[2]
Universal Health Coverage (UHC) is defined as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship”. The concept of UHC is based on non-discriminatory principles to build health systems that prioritize needs of the intended population by granting universal and reasonable access to healthcare. This means that although healthcare is not offered free of charge, there is less financial risk for users of care, and potentially providers and payers as well.
What are the relevant global sources?
At present there are no global sources that clearly link equitable financing to health and human rights. However, human rights frameworks and guiding principles to a certain extent can help prevent financial hardships that restrict individuals from accessing care.
- United Nations (UN) Human Rights Council – UN Guiding Principles on Business and Human Rights encourage lending institutions to provide credit to underserved populations, which in turn could be used to pay for healthcare.
- Human Rights and Sustainable Finance – Exploring the Relationship (Working Paper) offers current research perspectives on how governance structures can be strengthened to address financing challenges, including protecting livelihoods of those below the poverty line.
What are relevant human rights problems regarding healthcare financing?
National / government level:
- UHC policy: At the national level, a comprehensive policy on universal health coverage may not exist, or it may not be aligned to the health needs of the intended population. There could be a lack of mechanisms needed to implement UHC – such as a coordinating body, legal mandate in national legislation, and collaboration with rights-based organisations to ensure that all citizens are represented in policy development and implementation.
- Corruption & bureaucracy: Corrupt or bureaucratic practices and systems reduce spending effectiveness. This means that money allocated towards a particular health programme or a population group may not reach its intended purpose or recipient. Lack of trust in the public system could prevent aid organizations to provide concessional loans or grants that could further support healthcare initiatives.
- Price controls: A lack of price controls on medicines or health technologies may result in products that are priced at the discretion of pharmaceutical companies or market dynamics rather than population needs. In this case, certain healthcare products and services (including lifesaving interventions) could be out of reach for the population, especially if their prices are too high.
- Subsidies: Depending on the way citizens and governing bodies engage within a country or region, patients may not be aware of subsidies available to them for healthcare.
- Legal mandate for health insurance: A legal obligation to opt for health insurance may be missing in national regulations, which could be detrimental to certain population groups who may not be able to access lifesaving care and technology without health insurance.
Institutional
- Medical detention: In certain countries, those unable to pay healthcare bills are illegally detained by service providers – or denied access to lifesaving treatment.
- Informed prescription practices: Medical professionals could be incentivized to prescribe medicines or other products at higher costs when less expensive alternatives are available. Patients may incur higher expenses to pay for care, especially if they do not have enough information that enables them to choose more cost-effective options.
- Discriminatory practices: Discriminatory practices (i.e. based on income status or gender of care-seeker) may prevent certain marginalized groups from receiving care.
Personal
- Affordability: Prices of healthcare products or services are too high for the general population and hence care seeking would result in opportunity costs such as: missing out on education, nutrition, investments or paid-work hours. In addition, if the public health system does not sufficiently provide for the population, those with limited means incur disproportionate out-of-pocket expenses for health services.
- Marginalization: For example, women, children, asylum seekers, and non-earning family members may not have access to household income or external financing to pay for healthcare.
- Access to financial system: Not all individuals or households have access to bank accounts or other financial mechanisms to receive subsidies or cash transfers for healthcare.
- Health insurance coverage: Health insurance may not be available or well-understood. Not all population groups may be able to afford co-payments for health insurance coverage.
What can health workers and their professional organizations do?
National/government level:
- Generate empirical evidence on health outcomes, efficiency gains and health spending (i.e. multiplier effect which links health investments to exponential returns in productivity) to understand how resources can be allocated for optimal returns.
- Improve trust in public system by sharing information on use of funds in health and related outcomes.
- Advocate for UHC, mandatory health insurance and affordable pricing schemes for vulnerable populations.
- Improve access to formal financial system for general population to ensure that subsidies reach the intended recipient, especially in low income countries.
- Focus on areas that reduce future costs of healthcare like nutrition, drug safety or hygiene by preventing rapid disease transmission, adverse events or developmental disorders.
- Encourage patient participation in health policy dialogue and formation.
- Work with regulators to ensure minimal delay in priority health technologies reaching the market at affordable prices.
Institutional level:
- Encourage efficient and value-based practices in institutional policy to maintain high quality of care.
- Educate health workers on available health financing options.
- Connect with community leaders to raise awareness on health financing schemes.
- Promote inclusive pricing schemes for patients that do not discriminate on gender, income, disability, employment or citizenship status.
- Actively discourage practices that either disrespect patients or restrict care-seeking behavior.
Individual level:
- Prescribers should offer patients options that optimize value-for-money.
- Those in advisory positions should educate patients and providers on preventive care benefits to reduce unnecessary health spending.
- Skilled health workers can provide pro-bono training or services in under-served areas.
- Stay updated on technology and tools that help reduce medical costs vs quality.
- Support advocacy for rights-based approaches (RBA) to healthcare.
This page was written by Gauri Deoras in August 2019.
References
- Doherty J, Govender R. Washington: World Bank, World Health Organisation, Fogarty International Centre of the U.S. National Institutes of Health; 2004. The cost-effectiveness of primary care services in developing countries: a review of the international literature. Working Paper No. 37. Disease Control Priorities Project.
- https://www.who.int/news-room/detail/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses