Human rights health sector commercialisation and corruption Dr

Human rights, health sector commercialisation and corruption Dr Brigit Toebes, The University of Aberdeen School of Law b. toebes@abdn. ac. uk Toebes, May 2010

Framework for discussion: UN General Comment 14 on the Right to the Highest Attainable Standard of Health www. ohchr. org Toebes, May 2010

Right to health n Not a ‘right to be healthy’ Two dimensions: n Access to health care n Access to underlying conditions for health Toebes, May 2010

Right to health Three tools: n ‘AAAQ-AP’ n Obligations to ‘respect, protect and fulfil’ n Minimum core obligations Toebes, May 2010

AAAQ-AP n n Availability Accessibility Non-discrimination Physical accessibility Affordability Information accessibility n n Acceptability Quality Accountability Participation Toebes, May 2010

Tri-partite typology of State Obligations to respect n Obligations to protect n Obligations to fulfil n Toebes, May 2010

Minimum core obligations A ‘minimum package’ of health services n Programme of Action ICPD n Primary Health Care WHO n Millennium Development Goals Toebes, May 2010

Health care commercialisation Photo: Global Corruption Report 2006, Transparency International

Terminology n n Privatisation? Commercialisation? Toebes, May 2010

Why privatise? Reduce rising costs caused by Developed countries n Inefficiency n Ageing of the population n Improvements of medical techniques n Rising expectations n Over-consumption? Developing countries n Inefficiency n General poverty on the part of the government n Pressure from IFI’s and TNC’s Toebes, May 2010

The promise: Enhance the consumer’s range of choice Toebes, May 2010

Trends n health insurance health care provision multinational expansion n out-of-pocket expenditure n n Toebes, May 2010

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. ’ Toebes, May 2010

The public health perspective Mackintosh and Koivusalo: n n 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 Toebes, May 2010

Their conclusion: n n ‘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’ Toebes, May 2010

The human rights perspective Neutral, yet n. Serious human rights consequences n Toebes, May 2010

Relevant human rights n n Rights to information and political participation Right to health Right to a remedy Right to privacy Toebes, May 2010

AAAQ-AP n n Availability Accessibility Non-discrimination Physical accessibility Affordability Information accessibility n n Acceptability Quality Accountability Participation Toebes, May 2010

State obligations to respect, protect and fulfil Emphasis on State obligations to protect: n Regulate n Monitor n Provide redress Toebes, May 2010

The human rights impact assessment Availability n more efficiency? Accessibility n cost of health care? n Patients accepted? Acceptability n Medical data protected? Quality n Effects on the adequacy of the services? Accountability n Regulatory mechanisms in place? n Means of redress? Participation n Public informed and consulted? Toebes, May 2010

Health Sector Corruption Photo: Global corruption report Transparency

Health sector corruption Transparency International: Global Corruption Report 2006 – Corruption and Health Toebes, May 2010

Actors in the health sector State actor: n Governments and all their agents Non-state actors: n Healthcare providers (hospitals, health workers) n Health insurers n Consumers / patients n Suppliers (pharmaceutical industry) n Health researchers and educators Toebes, May 2010

Why is the health sector prone to corruption? Uncertainty n Asymmetric information n Large numbers of actors n Toebes, May 2010

Does it matter how a health sector is organised? n n Tax based Insurance based n public health care provision private healthcare provision n Decentralisation n Toebes, May 2010

A definition of corruption The misuse of entrusted power for private gain Toebes, May 2010

UN Convention on Corruption - 2003 n n n 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 Toebes, May 2010

‘HEALTH SECTOR CORRUPTION CAN AMOUNT TO VIOLATIONS OF THE RIGHT TO HEALTH’ Toebes, May 2010

Human rights and health sector corruption n n Right to health Right to life Non-discrimination Rights to information and political participation Right to a remedy Toebes, May 2010

‘Regulators’: the State and all its agents n n ‘AAAQ-AP’ Obligations to respect, protect and to fulfil Toebes, May 2010

AAAQ-AP n n Availability Accessibility Non-discrimination Physical accessibility Affordability Information accessibility n n Acceptability Quality Accountability Participation Toebes, May 2010

State obligation to respect Refrain from: n Bribery of officials in relation to health sector n Illicit enrichment n Misappropriation of funds n Trading in influence in the health sector n Abuse of function n Diverting drugs destined for country back to international drug market Toebes, May 2010

Obligation to protect Regulate the behaviour of: n State / regional and local governments n Health insurers n Hospitals n Health workers n Pharmaceutical industry n Consumers / patients Toebes, May 2010

State obligation to fulfil Adopt a coherent national policy to minimise the risk of corruption throughout the entire health system. Toebes, May 2010

Non-state actors Hospitals, health insurers, pharmaceutical companies n n ‘AAAQ-AP’ Respect, protect, fulfil Toebes, May 2010

Human rights violations? States n. Non-state actors n Toebes, May 2010

States n n n 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 Toebes, May 2010

Hospitals n n n Theft from hospital budget Unnecessary medical interventions Preferential treatment Toebes, May 2010

Health workers Informal payments? Photo: Global corruption report Transparency

Health Insurers n n n Adverse selection practices Refusal of patients on the basis of their health status, age, etc. Illegal billing of health care providers Toebes, May 2010

Pharmaceutical Industry n n n Influencing health care providers Excessive promotion of drugs Exerting pressure on drug selection process Toebes, May 2010

Thank you Toebes, May 2010