Problem

Jackson is fourteen years old and lives in New York City with his dad, Emmanuel. The family isn’t particularly wealthy, but Emmanuel’s job as a construction worker provides enough work and pay for them to afford a decent apartment. One day when Jackson returns home, he finds his dad with his leg in a cast. Emmanuel explains that he broke his leg and had to go to their local hospital’s emergency room. Jackson wants his father to focus on getting better, but Emmanuel’s too nervous. He doesn’t have insurance, and the hospital bills were way more expensive than he was expecting for a simple broken leg. Although they have some savings, Emmanuel can’t work while healing, and he doesn’t know how they’re going to pay off the hospital bill and rent in the meantime.

Explanation

Jackson and his dad face great financial loss. Even though they live in a wealthy city in one of the richest countries, they don’t have insurance and can’t afford to pay out-of-pocket, or use their own money. Access to and affordability of healthcare is drastically uneven across the world, even among the minority of countries that have established healthcare systems.

Access to Health Care and Affordability

Healthcare refers to the maintenance or improvement of individual physical and mental health through interventions, including health promotion, prevention, diagnosis, treatment, and recovery.

Access to healthcare is defined as timely access to services that lead to positive health outcomes. Access is often measured in terms of healthcare coverage and health infrastructure: how many doctors, hospital beds, vaccines, etc. there are. However, having the infrastructure to provide services and extending service coverage does not ensure access to care. Healthcare access also must take into account things like transportation, cultural competency, and cost. 

The definitions of affordability in terms of healthcare differ based on context and settings. Out-of-pocket costs will differ depending on the country’s healthcare system or lack thereof. The extent to which an individual or family can afford these costs depends on household income.

How it Works

Most middle- and high-income countries have a national or regional healthcare system that provides health services or health insurance to its population. Some systems are universal, and some are only eligible for specific populations.

Even if everyone is covered, that does not guarantee equal care access. Take the U.K., for example. Wealthy individuals can purchase private insurance or private care that’s often of higher quality or includes other amenities like short waiting times. Undocumented persons do not have access to any care other than emergency services.

The healthcare situation in the U.S. is even more complicated. People with either public or private insurance still have to make out-of-pocket payments. Uninsured people who can afford those payments might be fine as long as they remain healthy, but all it takes is one emergency for the bills to stack up. Meanwhile, insurance plans often don’t extensively cover huge expenses that are charged to those with chronic conditions or any long term care.

Access to healthcare is further limited by travel – providers and hospitals are often too far to walk to, and transportation there and back again can be expensive. Another barrier is culturally incompatible care. This can look like a language barrier or poor cross-cultural understanding or empathy for different beliefs, especially those related to health and health practices. All of these barriers force people to budget their care because they are uncomfortable or can’t afford to receive it. Their condition then gets worse, which increases the cost of the care they need.

Healthcare barriers in the United States are magnified immensely for countries without these structures and institutions. Millions of people risk falling into or deeper into poverty to pay for healthcare. Low- and middle-income countries face additional infectious diseases like Tuberculosis and Malaria, which are non-issues for countries with higher standards of living, on top of diseases we face, like heart disease and cancer. Additionally, low-income countries experience a disproportionate burden of natural disasters and complex humanitarian disasters, including armed conflicts and refugee crises. All of these events can threaten health infrastructure and health, further limiting access to healthcare. Thus the places with minimal access need accessible healthcare the most.

So What?

The majority of the world’s countries do not have established healthcare systems, so all healthcare costs are out-of-pocket. This creates a monetary barrier, denying many people access to care. Those who live in rural settings face greater obstacles and may rely on traditional medicine or clinics run by the government or non-profit organizations. But countries with health infrastructures and even healthcare systems do not guarantee access to healthcare. If they do, that doesn’t ensure their healthcare is affordable or culturally acceptable. Accessible, affordable healthcare is in short supply. 

Many of these systems and institutions don’t work because they aren’t operating under the assumption that health, and therefore healthcare, is a human right. You can help in your immediate and global community by voting and advocating for healthcare reform and those who support it. Get involved with organizations like Partners in Health, which works globally to provide healthcare to vulnerable and marginalized populations. Do your part to help make healthcare accessible and affordable to all.

    Learn More

    1. Rosling, Hans. “The best stats you’ve ever seen.” TED, Feb. 2006. www.ted.com/talks/hans_rosling_the_best_stats_you_ve_ever_seen?language=en. 
    2. “World Bank and WHO: Half the World Lacks Access to Essential Health Services, 100 Million Still Pushed into Extreme Poverty Because of Health Expenses.” World Health Organization, World Health Organization, www.who.int/news-room/detail/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses.
    3. Gawande, Atul. “Is Health Care a Right?” The New Yorker, Condé Nast, 2017, https://www.newyorker.com/magazine/2017/10/02/is-health-care-a-right?utm_source=twitter&utm_medium=social&utm_campaign=onsite-share&utm_brand=the-new-yorker&utm_social-type=earned. 
    4. Reid, Tom R. The Healing of America: a Global Quest for Better, Cheaper, and Fairer Health Care. Gale, 2010.

    Think Further

    1. Can you think of any examples of barriers to healthcare access in your own life and community? What were they? What do you think are some possible solutions?
    2. Which, if any, aspects of healthcare do you think everyone should have access to? Who should pay for it?
    3. If you were a presidential candidate, what would you say about healthcare access? Who is your key audience? 

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