Market-driven health care mess: the United States

In recent years the international debate about universality in health has been marked by a polarization between ideas based on a universal system, and notions proposing universal health coverage. The concept of universal coverage has been disseminated by international organizations and has been incorporated into health system reforms in several developing countries, including some in Latin America. This article explores the assumptions and strategies related to the proposal of universal health coverage. Firstly, a comparison is provided of the models of universal health coverage and universal health systems. This is followed by a contextualization of the international debate, including examples of different health systems. Finally, the implications of the proposal of universal coverage for the right to health in Brazil are discussed. The analysis of different concepts of universality and the experiences of different countries shows that health insurance-based models, either social or private, are not as satisfactory as public, universal health systems. Greater understanding about ongoing international projects is essential in order to identify the possibilities represented by the consolidation of the Unified Health System (SUS) in Brazil, as well as the risks of dismantling the SUS.

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“…Consumer tance of private, for-profit hospitals), financing, eligibility rules and basket of covered services 24 .…”

Section: Role Of Citizenmentioning

confidence: 99%

Sistema universal de saúde e cobertura universal: desvendando pressupostos e estratégias

Giovanella

Mendoza-Ruiz

Pilar

et al. 2018

Ciênc. saúde coletiva

120

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“…The U.S., where the healthcare market has achieved full maturity, has the largest rich/poor life expectancy gap in the industrial world, shortening life expectancy for the third consecutive year, increasing maternal mortality for the past twenty years, and very limited or no access to healthcare for 10% of its population [43].…”

Section: Taxpayers' Stakesmentioning

confidence: 99%

Neo-Hippocratic healthcare policies: professional or industrial healthcare delivery? A choice for doctors, patients, and their organisations

Unger

Morales

Paepe

et al. 2020

BMC Health Serv Res

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Background Ethical medical practice requires managing health services to promote professionalism and secure accessibility to care. Commercially financed and industrially managed services strain the physicians’ clinical autonomy and ethics because the industry’s profitability depends on commercial, clinical standardisation. Private insurance companies also reduce access to care whilst fragmenting and segmenting health systems. Against this background, given the powerful, symbolic significance of their common voice, physicians’ and patients’ organisations could effectively leverage together political parties and employers’ organisations to promote policies favouring access to professional care. Main text To provide a foundation for negotiations between physicians’ and patients’ organisations, we propose policy principles derived from an analysis of rights-holders and duty-bearers’ stakes, i.e., patients, physicians and health professionals, and taxpayers. Their concerns are scrutinised from the standpoints of public health and right to health. Illustrated with post-WWII European policies, these principles are formulated as inputs for tentative action-research. The paper also identifies potential stumbling blocks for collective doctor/patient negotiations based on the authors’ personal experience. The patients’ concerns are care accessibility, quality, and price. Those of physicians and other professionals are problem-solving capacity, autonomy, intellectual progress, ethics, work environment, and revenue. The majority of taxpayers have an interest in taxes being progressive and public spending on health regressive. Mutual aid associations tend to under-estimate the physician’s role in delivering care. Physicians’ organisations often disregard the mission of financing care and its impact on healthcare quality. Conclusion The proposed physicians-patients’ alliance could promote policies in tune with professional ethics, prevent European policies’ putting industrial concerns above suffering and death, bar care financing from the ambit of international trade treaties, and foster international cooperation policies consistent with the principles that inspire the design of healthcare policies at home and so reduce international migration. To be credible partners in this alliance, physicians’ associations should promote a public health culture amongst their members and a team culture in healthcare services. To promote a universal health system, patients’ organisations should strive to represent universal health interests rather than those of patients with specific diseases, ethnic groups, or social classes.

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“…Los discursos bioéticos del norte, con fuerte influencia de la ética biomédica, parecen estar más preocupados por la eficiencia financiera de su sistema de salud y con la rentabilidad de las empresas privadas que actúan en el sector, lo que Birn y Hellander denominaron 'market-driven health care' (cuidado de la salud conducido por el mercado) 23 . Por su parte, los discursos bioéticos del sur, representados en las propuestas de las bioéticas críticas aquí expuestas (Bioética de Protección y Bioética de Intervención), con fundamento en los derechos humanos, están comprometidos con cuestiones sociales y en la defensa intransigente de las poblaciones excluidas y marginadas, pauperizadas por acciones predatorias e imperialistas de los países ricos sobre los países pobres.…”

Section: Consideraciones Finalesunclassified

Acceso a cuidados de salud: discursos bioéticos del Norte y del Sur

Monteiro

Manchola-Castillo

2019

Saúde debate

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RESUMEN Estudio comparativo adoptando la técnica de investigación bibliográfica, mediante identificación y lectura de obras de referencia de consagrados autores de la bioética, con el objetivo de analizar discursos bioéticos sobre la temática del acceso a la salud en Estados Unidos y Brasil. Identificamos que el énfasis de los discursos estadounidenses está en la adquisición de bienes y servicios de salud y en estrategias para garantizar el acceso a seguros de salud, que es vista como una mercancía. Por el contrario, los discursos brasileños se centran en defender el derecho y acceso universal a la salud, que es vista como un valor social, un derecho humano fundamental. Los autores concluyen que los discursos bioéticos sobre el acceso a la salud encarnan diferentes perspectivas ético-políticas. En este sentido, las políticas de salud pueden promover – o no – los derechos humanos, incluyendo el derecho a la salud, dependiendo de cómo son concebidas o ejecutadas.

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Market-driven health care mess: the United States

Cited by 5 publications

References 7 publications

Sistema universal de saúde e cobertura universal: desvendando pressupostos e estratégias

Sistema universal de saúde e cobertura universal: desvendando pressupostos e estratégias

Neo-Hippocratic healthcare policies: professional or industrial healthcare delivery? A choice for doctors, patients, and their organisations

Acceso a cuidados de salud: discursos bioéticos del Norte y del Sur

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