People over profit: a paradigm shift essential to achieving health for all

People over profit: a paradigm shift essential to achieving health for all

By guest contributors Leigh Kamore Haynes, Ravi Ram, Shweta Marathe and Matheus Falçao

As the world looks to the other side of the COVID-19 pandemic, there is a clear opportunity to re-examine the systemic issues that underpin – or undermine – global health, including health equity, social justice and the decolonization of health systems. The privatization and commercialization of health, both in its financing and in the provision of services, is a key factor in the persistent gaps in health equity and social justice. The right to health has been deliberately set aside, even when these rights are codified in national constitutions.

In response to the continuing threat of degradation of health systems due to the privatization and commercialization of health services, health activists around the world have united on World Health Day (April 7 ) For amplify the call for strengthened public health systems that are patient- and worker-centred, reflect an equitable distribution of resources, and challenge colonial narratives of decision-making and power.

The problem of privatization: health for sale

Governments and international institutions systematically engage the private sector in efforts to build and strengthen health systems. the dominant reasoning is that the private sector can improve access, efficiency and quality. However, after nearly half a century of this approach, evidence from around the world shows otherwise. Philanthrocapitalists, companiesdevelopment banks and private financial companies, who wield irresponsible power, have shaped health financing policy to serve their interests. They have largely taken advantage of the idea that health is a commodity and not a right, subjugating action on the broader determinants of health.

In India, pro-privatization policies dating back to the 1990s led to the rise of the country’s private healthcare sector, which failed to meet India’s UHC goals. Currently, 70% of all patients are handled in the private sector and 70% of all health personnel work in the private sector. The cost of hospitalization is six times more expensive in private hospitals than in public hospitals, even though the government receives many complaints on professional misconduct in these private clinical establishments. Meanwhile, the national public health system is underfunded (only 1.2% of the country’s GDP funds health, well below the global average of 5%), resulting in overburdening of public health facilities. Yet the private sector in India remains poorly regulated And major health insurance plans launched under the guise of Universal Health Coverage (UHC) ignores critical evidence and depend on private hospitals.

Brazil’s Unified Health System (SUS) – official recognition of the country’s constitutional right to health – is one of the largest universal access public health systems in the world, covering a population of 220 million. Although every person living in Brazil is entitled to free health care, health expenditure data reflects a dual system that has emerged in the face of private sector engagement. Of the 9.6% of total GDP devoted to health, only 3.8% goes to SUS. The majority of spending goes to private health insurance, which covers about 25% of the population, and out-of-pocket expenses, including medication. The SUS suffers from underfunding, a lack of strong labor policies and rising costs. Although underfunded, the public system hit much more than market-driven health care. Despite the achievements of SUS, even announced by the World Bank– health commercialization has accelerated. In particular, outsourcing the management of the public system to the private sector through social health organizations diminishes public control over the system, creates fragmentation and has no advantages over the public model.

Kenya has seen a similar impact of the private sector diverting funds and health workers from the public sector. The country’s UHC program is managed by the National Hospital Insurance Fund, a parastatal organization, and funded through a voluntary subscription model. Under this model, household heads must regularly pay a monthly fee for coverage; a delay in payment results in a suspension of health coverage for 60 days even after the resumption of the subscription. In addition, public health services in Kenya remain overwhelmed by shortage of health personnel and drugs, which means that patients must seek treatment at private treatment centers. Private care providers negotiated higher reimbursement rates for the UHC basket of services, turning UHC into a profitable siphon of funds extracted from the general public. Moreover, the services covered by UHC focus on treatment, ignoring the broader spectrum of PHC, including health promotion and disease prevention, as these are not easily marketed. Nevertheless, Kenya’s new government expressed interest in expanding private sector participation in health and other public sectors through the World Bank model.

Even in countries with strong health systems and resources for health, as in many European countries, privatization and commercial practices restrict access to healthcare and, particularly in the hospital sector, more profitable patients are prioritized. In the United States, a system dominated by private interests, health spending exceeds the OECD average of nearly 10% Again health outcomes remain among the worst in the worldthe heaviest burden falls on migrants, the poor and racialized populations.

Solutions that embody human rights and equity

To achieve true health for all, bold solutions this center for human rights and equity is urgently needed.

  • To undo the damage caused by the privatization and commercialization of health systems, governments must focus on justice and human rights principles rather than the false logic of the market. Rebuilding equitable health systems requires decolonizing the power structures and institutions that determine health at the national level and in the global health architecture.
  • Equity requires social participation in health where health policy and associated accountability mechanisms are developed and implemented collectively, with public participation.
  • Significant efforts to financial justice can provide the financing needed to strengthen public health systems, usually through established mechanisms such as progressive taxation and redistributive tax policies that benefit society as a whole.

Health for all

“Our health is not for sale” is the statement of many health activists and advocates this year on World Health Day. Privatized and commercialized health care has not delivered on its promise to everyone; on the contrary, it has benefited those who wish to profit from the extracted profits. The current paradigm is, as has been demonstrated around the world, harmful to people’s health and detrimental to efforts to achieve health for all. As expected in the Santiago Declaration for Public Serviceshuman rights can be guaranteed for all when public services are “out of private control and under decolonial forms of collective, transparent and democratic control” in health and in all sectors.

About the authors:

Leigh Haynes is a lawyer and public health professional whose work and research lie at the intersection of public health and human rights. Haynes’ research and practice center on the right to health, focusing on the role that social movements and grassroots organizations play in influencing health policy. Locally and globally, Leigh advocates for health equity and social justice, focusing on the social, political and economic determinants that fuel health inequities. She is a longtime health activist and organizer with the People’s health movement and is part of the Simmons University School of Public Health. She’s on Twitter at @leighkamore

Ravi Ram is a health systems assessor and campaigner with the Kampala Initiative and the People’s health movement in Nairobi, Kenya. At the Madhira Institute, he leads gender-responsive and equity-focused analyzes and evaluations of the health sector and policies in sub-Saharan Africa and globally. Ravi is active in several civil society networks and sits on the board of Health Action Poverty and other progressive institutions. He’s on Twitter at @raviram

Shweta Marathe is a researcher at SATHI, Pune, India. With a decade of experience, she undertakes research that actively supports policy advocacy for a better health care system. His research interests focus on the transformations of the private health sector. Currently, she is a scholarship holder of the India-HPSR-2022 scholarship.

Matheus Falcao is a researcher at the Health Law Research Center (CEPEDISA) from the Health Law Research Support Center (NAP-DISA/USP) since 2013. He is a doctoral candidate in human rights with a thesis in the field of global health. He holds a master’s degree in law from the Faculty of Law of the University of São Paulo and has worked on research projects in partnership with PAHO/WHO. He focuses on health law, health systems and global health.

Disclaimer: Opinions expressed by contributors are solely those of the individual contributors, and not necessarily those of PLOS.

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