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Human rights, health sector commercialisation and corruption

Human rights, health sector commercialisation and corruption. Dr Brigit Toebes, The University of Aberdeen School of Law b.toebes@abdn.ac.uk. Framework for discussion:. UN General Comment 14 on the Right to the Highest Attainable Standard of Health www.ohchr.org. Right to health.

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Human rights, health sector commercialisation and corruption

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

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

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

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

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

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

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

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

  9. Terminology • Privatisation? • Commercialisation? Toebes, May 2010

  10. 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 IFI’s and TNC’s Why privatise? Reduce rising costs caused by Toebes, May 2010

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

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

  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.’ Toebes, May 2010

  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 Toebes, May 2010

  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’ Toebes, May 2010

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

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

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

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

  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? Toebes, May 2010

  21. Health Sector Corruption Photo: Global corruption report Transparency International, 2006

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

  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 Toebes, May 2010

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

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

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

  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 Toebes, May 2010

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

  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 Toebes, May 2010

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

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

  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 Toebes, May 2010

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

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

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

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

  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 Toebes, May 2010

  38. Hospitals • Theft from hospital budget • Unnecessary medical interventions • Preferential treatment Toebes, May 2010

  39. Health workersInformal payments? Photo: Global corruption report Transparency International, 2006

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

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

  42. Thank you Toebes, May 2010

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