The Burden of Medical Bills

negotiating-hospital-bills

During the economic crisis in Greece last year, a mother was about to commit suicide because she no longer had a job and could not afford paying for the medications of her chronically ill son. She would rather not live to see the day when her son would pass away in her arms. Here in the United States, just a few weeks ago, there was a partial government shutdown due to a dispute over Federal budget allocation to the Affordable Care Act. Meanwhile, across the border, Canadians have benefited from a great public health insurance system with minimum out-of pocket spending for many years.

When it comes to health financing, should there be any common universal ground rule on what proportion of the population should have health insurance in each country? During huge economic crises like the one that affected Greece, do the other countries have the duty to pitch in and save people from medical financial catastrophes?

As Savedoff points out, there is no magic bullet when it comes to allocating a budget for healthcare; even countries that approximately have the same GDP and the same level of care often times are spending different amount of money on healthcare depending on the needs of the population (Savedoff, 2007). One country might have a higher percentage of rural citizens and therefore allocate budget for transportation fees to promote access to hospitals, while the other country might not need that extra budget. What is undeniable, however, is that we need to find a way to reduce the number of people who are still victims of financial catastrophes due to medical bills, especially in low-income countries where out-of-pocket expenditure is highest.  This could be done by introducing a type of prepayment system through a form of insurance purchased by the citizen every month or every year (Ke Xu et al., 2007). Several low income countries today have come up with a public health insurance that at least provide primary care services for as low as $3 per year for poor families (‘Mutuelle’ Health insurance in Rwanda).

However, these low-income countries often have other problems that might take their attention away from trying to develop an appropriate health insurance scheme. Lack of specialized medical staff or lack of equipment would require allocating a portion of the budget to trainings and purchases of instruments. How can you mandate a country that just got out of a civil war, for example, to allocate a certain amount of money on health, instead of first focusing on rebuilding the infrastructure of the country?

I do agree that each country should allocate funding depending on its needs at the time, but the strong inequalities in healthcare service delivery between the rich and the poor within a country show that there is an underlying bias that needs to be addressed. It is the same groups that are always victimized. Good health budget allocation will reduce corruption at the service delivery level where the wealthy always use social capital to get the best services, while the poor who are spending a higher portion of their revenue on treatment receive the worse care.

References:

Savedoff William D. (2007). What should a country spend on Health Care? Health Affairs. 26 (4) 962-970.

Ke Xu, Evans David B., Carrin Guido, Aguilar-Rivera Ana Mylena, Musgrove Phillip, Evans Timothy. Protecting households From Catastrophic Health Spending. Health Affairs. 26 (4) 972-983.

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