Is there value in me paying for you?
User fees and risk pooling seem to be recurring themes in global public health. Many countries have instituted risk pooling policies which cover the broad majority of population through state/federally funded health care systems, social and community based insurance and voluntary health insurance.[i] Many of which include a user fee that is designed to motivate people to go to the doctor when necessary and eliminate unnecessary visits. As the deadline for implementing Millennium Development Goals quickly approaches global health policy is top priory on the international policy agenda. Health financial inequities spell out great consequences for the health of the world’s poor in developing and developed countries alike. There has been much discussion on the ‘right to health’ as defined by the WHO[ii] as well as narrower focuses on communal/global health, governments role in health care systems, how to address broadening health disparities in low and middle income countries.
So if health care is a right why are so many without it? Should the masses pay for the minority? If the masses are to pay for the minority where do the funds come from? There seem to be more questions than the literature has answers. I would be all for footing the bill of the poorer if and only if the funds were actually allocated and utilized for them. I am all for comprehensive health care insurance plans but only when they are truly comprehensive and free of user fee’s or at best low cost (income based) fees making it somewhat affordable for most. Having had a friend diagnose with a brain tumor and witnessed the financial ruin he has endured by being underemployed, uninsured, and denied government health care, I have a hard time buying into risk pooling as a solution to serving the poor and disenfranchised. In a global context, it would benefit the world to foot the bill for the sick which would enrich the health and productivity of the population and aid in the developmental growth of middle and low income countries. It would also reduce the risk of pandemics as we become more of a migratory society with travel (air, train, and bus) reducing the geographical size of the world.
[i] Gottret, P, Schieber, G. (2006) “Health financing revisited: a practitioner’s guide, Overview,” World Bank Publication, pp. 318.
[ii] Constitution of the World Health Organization, in Basic Documents, Thirty-ninth Edition, World Health Organization, 1992.