Taking the Right to Health Care Seriously

1. Institute of Health Policy and Management Taking the Right to Health Care Seriously Martin Buijsen Health Care Rationing Conference Rotterdam, 9 December 2010 Contact: buijsen@bmg.eur.nl

2. Institute of Health Policy and Management Contents • Introduction • Human rights & health care • The right to health care • Parameters for reform • Implications

3. Institute of Health Policy and Management Introduction • Radical overhaul of the Dutch health care system in 2006 • From Bismarck to managed competition • Accessible and affordable health care of good quality for everyone (end) • Introduction of market forces (means) • Law as capstone of national policy • No references to international human rights law by legislator

4. Institute of Health Policy and Management Human Rights & Health Care • National policies are preceded by law as well • Human rights precede policy • Human rights and human dignity • Social rights and their (lack of) justiciability • Social rights are NOT second class human rights • The right to health care as parameter for systems’ reform

5. Institute of Health Policy and Management The Right to Health care • Internationally recognized as a human right • State obligations to realize the right to health care progressively • State obligations to ensure access to necessary health care • Equal access to necessary health care • Justice as equal treatment ‘at the gate’ • Core content of the right to health care • Justice and collective choices in health care

6. Institute of Health Policy and Management The Right to Health care • Injustice ‘at the gate’ • Criteria of merit • Increased use • Insidious use • Use of criteria of merit as implicit rationing • Implicit rationing of health care: what? • Injustice and collective choices in health care • Failing to meet the requirements of the core content

7. Institute of Health Policy and Management Parameters for Reform • Respecting the right to health care implies: • A state obligation to ensure equal access, i.e. to prevent discrimination • A state obligation to meet the requirements of the core content • A state obligation to realize it progressively

8. Institute of Health Policy and Management Parameters for Reform • Further implications: • Treatment as an equal ‘at the gate’ implies true treatment: patients are entitled to correct information. If a patient cannot access necessary health care because of lack of money, he or she should be told so. 4. A state obligation to ensure true treatment • Treatment as an equal implies an individual right of participation in the collective decision making process. Public health strategies and plans of action ought to be developed (and periodically reviewed) on the basis of a participatory and transparent process. 5. A state obligation to ensure participation and transparency in collective decision making.

9. Institute of Health Policy and Management Implications • For the Dutch system of health care the human rights framework is especially relevant in two ways • There seems to be a tendency towards discrimination. However, differences in treatment ‘at the gate’ on other grounds than differences in objective need cannot be justified. • There seems to be a tendency towards implicit rationing and less and less individual involvement in the collective decision making process. There should be participation. Deliberation should be comprehensive, rational, transpa-rent and democratically legitimized.