Lecture for
4th year medical students Salman University Kharj on May 21, 2013 by
Professor Omar Hasan Kasule, Sr.
Expenditure on health is rising in all countries. Health expenditure
constitutes a high proportion of GDP. Per capita health expenditure is also
very high. There are in addition unrecorded health expenditures such as
out-of-pocket payments and payments in-kind. The reasons for rising health care
costs are higher demand for care, higher wages of health care workers, more
sophisticated, and expensive medical technology. The rising costs of health
have forced a review of the issue of access. Managed care is managed costs.
Rationing health care and prioritizing coverage have also been considered. In practice the zeal to control
costs has serious side effects such as inadequate care, inappropriate care,
exclusion of high risk patients like the elderly, and lack of equity in health
care delivery
Several methods are used to pay
for health services: direct physician payments, national insurance, social
insurance, commercial insurance and third party payors. Physician payments may
be fee for service or may be on a capitation basis. Insurance and third party
payors rely on actuarial principles in pooling risk in order to set the
premiums. They protect the consumer from a high risk of catastrophic medical
bills.
JUSTICE ISSUES IN HEALTH CARE
FINANCING
Issues of justice in health care can be classified as distributive
justice or allocative priorities. Distributive justice deals with access to
care, affordability of care, and quality of care. Allocation priorities involve
differential allocation of scarce health care resources among rural vs urban
areas; curative vs preventive medicine; and administrative vs. actual care
costs.
Access to good health care is limited by financial, cultural, and
distance barriers. Patients who need
care may not get it because it is beyond their ability to pay. Members of
minority groups or immigrants may be reluctant to seek care in a health care
environment that they perceive to be hostile or that does not respect their
cultural and religious sensitivities. Some of the underprivileged members of
society in most need of may not have the information about where to seek care.
This relates often to their low level of education. For others health care may
too far away and they cannot afford or find transportation. The quality of care
provided may also be a barrier to access. Patients may decide not to attend
healthcare facilities that they perceive to be providing poor health care.
Allocation priorities confront decision makers who have to make hard
choices to allocate limited health care resources. It is difficult enough to
determine allocation priorities based on objective data of medical need. It is
even more difficult to make such decisions in the face of political demands and
lobbying by various interest groups. Rural health care is often neglected at
the expense of urban areas because urban areas have more vocal advocates.
Curative care takes a disproportionately higher budgetary allocation than the
more effective preventive care. The huge healthcare bureaucracies with big
overhead administrative overhead expenditures may end up using a
disproportionate share of the health care budget on administration rather than
on direct medical care.
No policy decisions can please everybody but an attempt must be made to
allocate health care resources equitably so that all citizens have access to
quality care.
DISCUSSION QUESTIONS
- For a healthcare jurisdiction that you know, identify 2 barriers of access to health care and suggest ways of overcoming them.
- What is your opinion about the following statement ‘Free medical care is a basic human right for every citizen’
- What do you understand by the term ‘rationing health care’. How is it carried out? What are the advantages and what are the disadvantages?