What we need for equitable access to healthcare: public financing for the public good

By Marco Angelo, global health advocate at Wemos

On World Health Day, we need to talk about solving a major threat for universal and equitable access to healthcare: commercialisation. Profit incentives have become dominant in health service delivery in many countries. A focus on profit makes these services too expensive for poorer populations and does not necessarily lead to addressing the most urgent medical needs. To achieve universal and equitable access, governments and multilateral organisations and funds should prioritise public financing of healthcare systems for the public good.

Right to health

Today, the 7th of April, is World Health Day, marking the anniversary of the founding of the World Health Organization (WHO) in 1948. According to its constitution, the WHO was founded to fulfil the right to health, a right belonging to ‘every human being, without distinction of race, religion, political belief, economic or social condition’. This was a period, after the horror of two World Wars, when leaders of all the nations decided to move past differences and conflicts to build a new world order founded on peace and human rights, and the principles of universality and equal access to healthcare were embedded in the WHO constitution.

Commercial interests

Despite these principles, 74 years after the founding of the WHO, the global health landscape is still as unequal as ever. In many poor countries, public healthcare has been neglected, and the private health sector came in to fill the gaps. Additionally, many development actors focus on expanding or creating markets for private actors in low- and middle-income countries and use public resources to finance or de-risk private investments. This led to an increasing role for commercial actors in health service delivery.

Undermining access to healthcare

While there is nothing intrinsically negative in private hospitals and clinics, focusing only on commercial interests and private financing mechanisms can undermine universal and equitable access to healthcare. When private hospitals are not embedded in a public financing system, they are financed through private insurances and user fees, which are often unaffordable for the poor.

The Covid-19 pandemic clearly showed the shortcomings of cutting public health expenditure and allowing commercial finance to fill the gap. Countries that relied more on private health financing performed worse to reduce Covid-19 mortality. In many countries, private hospitals refused to accept patients who could not afford the costs, or to treat cases that were deemed too expensive for the providers. Many patients were overcharged, as documented by our partners in India, for example. Furthermore, the crisis revealed the vulnerability of private providers, as they suffered economic losses due to the high cost of Covid-19 treatments and a fall in revenues from other treatments.

Safety network

Additionally, the pandemic highlighted the importance and the potential of public financing for healthcare. When healthcare providers are backed by a strong public financing system, this provides a safety network during health crises and grants a more equitable access to health services. The last WHO report on health expenditure showed that countries’ response to the Covid-19 pandemic was financed primarily through increased government health spending. Despite years of a narrative about the need for fiscal consolidation and austerity, public financing turned out to be what is really needed for health systems.

On World Health Day, Wemos affirms the need for healthcare systems that grant universal and equitable access, that are publicly financed and socially accountable.

To know more about how development actors support private health financing and thus jeopardise universal and equitable access, read our inventory study ‘Improving healthcare, but for whom?’, in which we analyse the work of the International Financing Corporation (the private sector’s arm of the World Bank) in health.

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