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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

Human rights,health sectorcommercialisationand corruption

Dr Brigit Toebes,

The University of Aberdeen

School of Law

b.toebes@abdn.ac.uk

Toebes, May 2010

framework for discussion

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
Right to health
  • Not a ‘right to be healthy’

Two dimensions:

  • Access to health care
  • Access to underlying conditions for health

Toebes, May 2010

right to health1
Right to health

Three tools:

  • ‘AAAQ-AP’
  • Obligations to ‘respect, protect and fulfil’
  • Minimum core obligations

Toebes, May 2010

aaaq ap
AAAQ-AP
  • Availability
  • Accessibility

Non-discrimination

Physical accessibility

Affordability

Information accessibility

  • Acceptability
  • Quality
  • Accountability
  • Participation

Toebes, May 2010

tri partite typology of state obligations

Tri-partite typology of State Obligations

Obligations to respect

Obligations to protect

Obligations to fulfil

Toebes, May 2010

minimum core obligations
Minimum core obligations

A ‘minimum package’ of health services

  • Programme of Action ICPD
  • Primary Health Care WHO
  • Millennium Development Goals

Toebes, May 2010

health care commercialisation

Health care commercialisation

Photo: Global Corruption Report 2006, Transparency International

terminology
Terminology
  • Privatisation?
  • Commercialisation?

Toebes, May 2010

why privatise reduce rising costs caused by
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

the promise

The promise:

Enhance the consumer’s range of choice

Toebes, May 2010

trends
Trends
  • health insurance
  • health care provision
  • multinational expansion
  • out-of-pocket expenditure

Toebes, May 2010

british medical association 2006

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
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

their conclusion
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

the human rights perspective

The human rights perspective

Neutral, yet

Serious human rights consequences

Toebes, May 2010

relevant human rights
Relevant human rights
  • Rights to information and political participation
  • Right to health
  • Right to a remedy
  • Right to privacy

Toebes, May 2010

aaaq ap1
AAAQ-AP
  • Availability
  • Accessibility

Non-discrimination

Physical accessibility

Affordability

Information accessibility

  • Acceptability
  • Quality
  • Accountability
  • Participation

Toebes, May 2010

state obligations to respect protect and fulfil
State obligations to respect, protect and fulfil

Emphasis on State obligations to protect:

  • Regulate
  • Monitor
  • Provide redress

Toebes, May 2010

the human rights impact assessment
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

health sector corruption
Health Sector Corruption

Photo: Global corruption report Transparency International, 2006

health sector corruption1
Health sector corruption

Transparency International:

Global Corruption Report 2006 –

Corruption and Health

Toebes, May 2010

actors in the health sector
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

why is the health sector prone to corruption
Why is the health sector prone to corruption?
  • Uncertainty
  • Asymmetric information
  • Large numbers of actors

Toebes, May 2010

does it matter how a health sector is organised
Does it matter how a health sector is organised?
  • Tax based
  • Insurance based
  • public health care provision
  • private healthcare provision
  • Decentralisation

Toebes, May 2010

a definition of corruption

A definition of corruption

The misuse of entrusted power for private gain

Toebes, May 2010

un convention on corruption 2003
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

human rights and health sector corruption
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

regulators the state and all its agents
‘Regulators’: the State and all its agents
  • ‘AAAQ-AP’
  • Obligations to respect, protect and to fulfil

Toebes, May 2010

aaaq ap2
AAAQ-AP
  • Availability
  • Accessibility

Non-discrimination

Physical accessibility

Affordability

Information accessibility

  • Acceptability
  • Quality
  • Accountability
  • Participation

Toebes, May 2010

state obligation to respect
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

obligation to protect
Obligation to protect

Regulate the behaviour of:

  • State / regional and local governments
  • Health insurers
  • Hospitals
  • Health workers
  • Pharmaceutical industry
  • Consumers / patients

Toebes, May 2010

state obligation to fulfil

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
Non-state actors

Hospitals, health insurers, pharmaceutical companies

  • ‘AAAQ-AP’
  • Respect, protect, fulfil

Toebes, May 2010

human rights violations

Human rights violations?

States

Non-state actors

Toebes, May 2010

states
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

hospitals
Hospitals
  • Theft from hospital budget
  • Unnecessary medical interventions
  • Preferential treatment

Toebes, May 2010

health workers informal payments
Health workersInformal payments?

Photo: Global corruption report Transparency International, 2006

health insurers
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

pharmaceutical industry
Pharmaceutical Industry
  • Influencing health care providers
  • Excessive promotion of drugs
  • Exerting pressure on drug selection process

Toebes, May 2010

thank you

Thank you

Toebes, May 2010