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Human rights, health sector commercialisation and corruption

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Human rights, health sector commercialisation and corruption Dr Brigit Toebes, The University of Aberdeen School of Law b.toebes_at_abdn.ac.uk Toebes, May 2010 – PowerPoint PPT presentation

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Title: Human rights, health sector commercialisation and corruption


1
Human rights,health sectorcommercialisationand
corruption
  • Dr Brigit Toebes,
  • The University of Aberdeen
  • School of Law
  • b.toebes_at_abdn.ac.uk

2
Framework for discussion
  • UN General Comment 14 on the Right to the Highest
    Attainable Standard of Health
  • www.ohchr.org

3
Right to health
  • Not a right to be healthy
  • Two dimensions
  • Access to health care
  • Access to underlying conditions for health

4
Right to health
  • Three tools
  • AAAQ-AP
  • Obligations to respect, protect and fulfil
  • Minimum core obligations

5
AAAQ-AP
  • Availability
  • Accessibility
  • Non-discrimination
  • Physical accessibility
  • Affordability
  • Information accessibility
  • Acceptability
  • Quality
  • Accountability
  • Participation

6
Tri-partite typology of State Obligations
  • Obligations to respect
  • Obligations to protect
  • Obligations to fulfil

7
Minimum core obligations
  • A minimum package of health services
  • Programme of Action ICPD
  • Primary Health Care WHO
  • Millennium Development Goals

8
Health care commercialisation
9
Terminology
  • Privatisation?
  • Commercialisation?

10
Why privatise? Reduce rising costs caused by
  • Developed countries
  • Inefficiency
  • Ageing of the population
  • Improvements of medical techniques
  • Rising expectations
  • Over-consumption?
  • Developing countries
  • Inefficiency
  • General poverty on the part of the government
  • Pressure from IFIs and TNCs

11
The promise
  • Enhance the consumers range of choice

12
Trends
  • health insurance
  • health care provision
  • multinational expansion
  • out-of-pocket expenditure

13
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.

14
The public health perspective
  • Mackintosh and Koivusalo
  • 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

15
Their conclusion
  • 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

16
The human rights perspective
  • Neutral, yet
  • Serious human rights consequences

17
Relevant human rights
  • Rights to information and political participation
  • Right to health
  • Right to a remedy
  • Right to privacy

18
AAAQ-AP
  • Availability
  • Accessibility
  • Non-discrimination
  • Physical accessibility
  • Affordability
  • Information accessibility
  • Acceptability
  • Quality
  • Accountability
  • Participation

19
State obligations to respect, protect and fulfil
  • Emphasis on State obligations to protect
  • Regulate
  • Monitor
  • Provide redress

20
The human rights impact assessment
  • Availability
  • more efficiency?
  • Accessibility
  • cost of health care?
  • Patients accepted?
  • Acceptability
  • Medical data protected?
  • Quality
  • Effects on the adequacy of the services?
  • Accountability
  • Regulatory mechanisms in place?
  • Means of redress?
  • Participation
  • Public informed and consulted?

21
Health Sector Corruption
22
Health sector corruption
  • Transparency International
  • Global Corruption Report 2006
  • Corruption and Health

23
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

24
Why is the health sector prone to corruption?
  • Uncertainty
  • Asymmetric information
  • Large numbers of actors

25
Does it matter how a health sector is organised?
  • Tax based
  • Insurance based
  • public health care provision
  • private healthcare provision
  • Decentralisation

26
A definition of corruption
  • The misuse of entrusted power for private gain

27
UN Convention on Corruption - 2003
  • 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

28
HEALTH SECTOR CORRUPTION CAN AMOUNT TO
VIOLATIONS OF THE RIGHT TO HEALTH
29
Human rights and health sector corruption
  • Right to health
  • Right to life
  • Non-discrimination
  • Rights to information and political participation
  • Right to a remedy

30
Regulators the State and all its agents
  • AAAQ-AP
  • Obligations to respect, protect and to fulfil

31
AAAQ-AP
  • Availability
  • Accessibility
  • Non-discrimination
  • Physical accessibility
  • Affordability
  • Information accessibility
  • Acceptability
  • Quality
  • Accountability
  • Participation

32
State obligation to respect
  • Refrain from
  • Bribery of officials in relation to health sector
  • Illicit enrichment
  • Misappropriation of funds
  • Trading in influence in the health sector
  • Abuse of function
  • Diverting drugs destined for country back to
    international drug market

33
Obligation to protect
  • Regulate the behaviour of
  • State / regional and local governments
  • Health insurers
  • Hospitals
  • Health workers
  • Pharmaceutical industry
  • Consumers / patients

34
State obligation to fulfil
  • Adopt a coherent national policy to minimise the
    risk of corruption throughout the entire health
    system.

35
Non-state actors
  • Hospitals, health insurers, pharmaceutical
    companies
  • AAAQ-AP
  • Respect, protect, fulfil

36
Human rights violations?
  • States
  • Non-state actors

37
States
  • 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

38
Hospitals
  • Theft from hospital budget
  • Unnecessary medical interventions
  • Preferential treatment

39
Health workersInformal payments?
40
Health Insurers
  • Adverse selection practices
  • Refusal of patients on the basis of their health
    status, age, etc.
  • Illegal billing of health care providers

41
Pharmaceutical Industry
  • Influencing health care providers
  • Excessive promotion of drugs
  • Exerting pressure on drug selection process

42
Thank you
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