Transcript Taking a human rights approach to health care

Human rights,
health sector
commercialisation
and corruption
Dr Brigit Toebes,
The University of Aberdeen
School of Law
[email protected]
Toebes, May 2010
Framework for discussion:
UN General Comment 14 on the Right to the
Highest Attainable Standard of Health
www.ohchr.org
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Right to health

Not a ‘right to be healthy’
Two dimensions:
 Access to health care
 Access to underlying conditions for health
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Right to health
Three tools:
 ‘AAAQ-AP’
 Obligations to ‘respect, protect and fulfil’
 Minimum core obligations
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AAAQ-AP
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Availability
Accessibility
Non-discrimination
Physical accessibility
Affordability
Information accessibility
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Acceptability
Quality
Accountability
Participation
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Tri-partite typology of State
Obligations
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Obligations to respect
Obligations to protect
Obligations to fulfil
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Minimum core obligations
A ‘minimum package’ of health services
 Programme of Action ICPD
 Primary Health Care WHO
 Millennium Development Goals
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Health care
commercialisation
Photo: Global Corruption Report 2006,
Transparency International
Terminology
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Privatisation?
Commercialisation?
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Why privatise?
Reduce rising costs caused by
Developed countries
 Inefficiency

Ageing of the population
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Improvements of medical
techniques
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Rising expectations

Over-consumption?
Developing countries
 Inefficiency
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General poverty on the part of
the government

Pressure from IFI’s and TNC’s
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The promise:
Enhance the consumer’s range of choice
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Trends
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health insurance
health care provision
multinational expansion

out-of-pocket expenditure
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British Medical Association
2006
‘There should be no further involvement of the
commercial private sector in providing NHS care. The
BMA will campaign to restore an integrated publicly
provided health service in England.’
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The public health perspective
Mackintosh and Koivusalo:
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Better health care at birth when more of GDP spent by
government or social insurance funds on health care
Greater exclusion of children from treatment when ill
when higher primary care commercialisation
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Their conclusion:
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‘Health systems are part of the public policy sphere’
‘Policies towards commercialization within health
systems should and can be within national and local
democratic control’
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The human rights perspective
Neutral, yet
Serious human rights consequences
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Relevant human rights
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Rights to information and political participation
Right to health
Right to a remedy
Right to privacy
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AAAQ-AP
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Availability
Accessibility
Non-discrimination
Physical accessibility
Affordability
Information accessibility




Acceptability
Quality
Accountability
Participation
Toebes, May 2010
State obligations to respect, protect
and fulfil
Emphasis on State obligations to protect:
 Regulate
 Monitor
 Provide redress
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The human rights impact assessment
Availability

more efficiency?
Accessibility

cost of health care?
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Patients accepted?
Acceptability
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Medical data protected?
Quality
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Effects on the adequacy of the services?
Accountability
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Regulatory mechanisms in place?
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Means of redress?
Participation
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Public informed and consulted?
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Health Sector Corruption
Photo: Global corruption report Transparency
International, 2006
Health sector corruption
Transparency International:
Global Corruption Report 2006 –
Corruption and Health
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Actors in the health sector
State actor:
 Governments and all their agents
Non-state actors:
 Healthcare providers (hospitals, health workers)
 Health insurers
 Consumers / patients
 Suppliers (pharmaceutical industry)
 Health researchers and educators
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Why is the health sector prone to
corruption?
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Uncertainty
Asymmetric information
Large numbers of actors
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Does it matter how a health sector is
organised?
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Tax based
Insurance based
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public health care provision
private healthcare provision

Decentralisation
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A definition of corruption
The misuse of entrusted power
for private gain
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UN Convention on Corruption - 2003
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Bribery of national and foreign public officials
Bribery in the private sector
Embezzlement of property by a public official
Trading in influence
Abuse of functions
Illicit enrichment
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‘HEALTH SECTOR CORRUPTION
CAN AMOUNT TO VIOLATIONS OF
THE RIGHT TO HEALTH’
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Human rights and health sector
corruption
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Right to health
Right to life
Non-discrimination
Rights to information and political participation
Right to a remedy
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‘Regulators’:
the State and all its agents
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‘AAAQ-AP’
Obligations to respect, protect and to fulfil
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AAAQ-AP


Availability
Accessibility
Non-discrimination
Physical accessibility
Affordability
Information accessibility




Acceptability
Quality
Accountability
Participation
Toebes, May 2010
State obligation to respect
Refrain from:
 Bribery of officials in relation to health sector
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Illicit enrichment
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Misappropriation of funds
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Trading in influence in the health sector
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Abuse of function
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Diverting drugs destined for country back to international drug
market
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Obligation to protect
Regulate the behaviour of:
 State / regional and local governments
 Health insurers
 Hospitals
 Health workers
 Pharmaceutical industry
 Consumers / patients
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State obligation to fulfil
Adopt a coherent national policy to minimise
the risk of corruption throughout the entire
health system.
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Non-state actors
Hospitals, health insurers, pharmaceutical companies
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‘AAAQ-AP’
Respect, protect, fulfil
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Human rights violations?
States
Non-state actors
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States
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embezzlement and stealing money from the health
budget
misappropriation of funds that had been allocated to
the health sector
accepting a bribe in exchange for the construction
permit for a hospital
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Hospitals
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Theft from hospital budget
Unnecessary medical interventions
Preferential treatment
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Health workers
Informal payments?
Photo: Global corruption report Transparency
International, 2006
Health Insurers
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Adverse selection practices
Refusal of patients on the basis of their health status,
age, etc.
Illegal billing of health care providers
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Pharmaceutical Industry
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Influencing health care providers
Excessive promotion of drugs
Exerting pressure on drug selection process
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Thank you
Toebes, May 2010