Healthcare A Right or Privilege?

Healthcare as a right or privilege is one of the oldest debates but it is increasingly strengthening in our current society after the catastrophic COVID-19 pandemic. 

However, before getting to the heart of the matter, we need to define some crucial concepts in order to have all the keys to debate. 

What is a right and what is a privilege in healthcare?  

Simplifying the concept of a right, it is something we are entitled to because we exist as human beings, regardless of our race, sex, nationality, ethnicity, language, religion, or any other status. 

Privilege is a special right or advantage of only one person or group. 

Healthcare is the service of providing medical care by trained and licensed professionals in order to maintain or restore health through the treatment and prevention of disease. 

So, to answer the question if healthcare should be a right or a privilege is to know if everyone as human beings should have access to free healthcare or if access to healthcare should be a privilege and limited to the group that pays. 

Healthcare As a Right  

When we speak of healthcare as a right, the concept refers to universal healthcare or universal health coverage, which means access for everyone to the full range of quality health services all human beings could need. 

In relation to this concept, health must be accessible and affordable for all. The government of each country must ensure health access to its citizens and population, since a healthy population means people capable of working and generating positive economic impacts and people capable of studying. As a direct consequence, they will bring future wealth to the country. Indeed, health, from an economic perspective, is key to economic growth, social well-being and human development. 

Historically, great economic progress in the world has been accompanied by an improvement in the health and nutritional conditions of the population. Therefore, for a country, investment in health means social well-being and reduction of poverty and inequality. The decrease in mortality and the growth in per capita income are a direct consequence of both improved nutrition and health conditions and advances in medical technology. For this reason, as of the 21st century, Mexico has emerged as one of the nations with wide potential for economic growth, in part thanks to its public health policies ,starting with Porfirio Diaz at the beginning of the 20th century. 

From this point of view, it seems obvious that healthcare should be a right, as large-scale childhood vaccination campaigns, for example, or control of numerous infectious diseases definitely have contributed to economic growth. 

However, according to the World Health Organization (WHO), about 100 million people around the world every year are pushed below the poverty line as a result of health expenses. 

So, is access to healthcare as a right a utopia reserved for a few countries and is it more viable as a privilege? 

Healthcare As a Privilege  

It seems to be. Indeed, according to the WHO, approximately 50 of over 206 countries have achieved universal or almost universal health coverage. That is less than 25%! 

Actually, according to the APRIL International Care report, the classification of the world's health systems shows that only countries with a high per capita income enjoy a good health status and an efficient universal health system. 

So, the reality is that in our current world, access to health is a privilege. And many argue that it will remain as such because a universal healthcare system is only achievable in developed countries with very low inequality. 

The United Sistem or American system of healthcare is an example of healthcare as a privilege as healthcare access depends on your capacity to work. Work is the crucial condition to have access to healthcare. This argument is quite valid as work allows people to earn money and save for health to ensure access to the privilege of healthcare for themselves and for their children. As these individuals work, they pay into Medicare, which  is a system that ensures that hardworking people will retain access to healthcare when they are no longer capable of work. 

This system is quite interesting as it forces people to be productive as workers, so the direct impact on the economy should be positive too. Moreover, this system seems more viable as the individual is participating in the cost of healthcare, making it a shared responsibility between the government and individuals. 

The problem of such a system is around those who are not productive members of society. Do they not deserve access to healthcare? If we analyze healthcare as a privilege, we enter rapidly into a vicious circle: if part of the population doesn't have access to healthcare, part of the country can’t have favorable growth and for that matter can’t reduce or eliminate the inequality gap.

Situation in Mexico  

According to CEOWorld Magazine’s Healthcare Index, in which over 89 countries qualified, Mexico appears at position 29. This index analyzes the overall quality of the healthcare system, including the healthcare infrastructure, the competencies of health professionals (physicians, nurses, and other health workers), the cost, quality, and availability of drugs, and finally, the preparation of the government. 

According to data from the Pan American Health Organization, Mexico has built a strategic health program for people’s well-being called Bienestar, with a focus on human rights. The goal is to have a positive impact  on key social and health issues that trigger inequalities. The final goal of that policy is that any person, independently of their economic, social and cultural conditions, can receive comprehensive and efficient healthcare. As such, Mexican policy wants healthcare to be a right. 

But, that system is running into several bottlenecks that are generating inefficiencies, and these are growing. Clearly, they have not succeeded in managing effective coordination of medical care and public health. 

Medical care, even if it is quality care, is too slow. The average response times are too long. The Center for Economic and Budgetary Research (CIEP), in its document entitled Universal Health System: Coverage and Financing Challenges, highlights that the waiting time to enter a medical consultation at a public health institution (IMSS, ISSSTE) is about 91 minutes. This is equivalent to 2.9 times more than that of other institutions, such as those in the private sector. 

In addition, in the same document, waiting times and productivity for seven surgical procedures and four diagnostic procedures selected on the basis of their relative frequency and comparability with other national health systems were analyzed. Results: the average waiting time for the seven surgical procedures was about 14 weeks! 

As a consequence, a large part of the population prefers to pay to receive an instant medical service instead of having to wait within the public sector. So, instead of helping the population to have access to a public healthcare system without cost, the inadequacy of the system forces the population to go to the private sector and spend from their own pocket. 

According to the Center for Economic and Budgetary Research, in Mexico, the public system service rates are below 43%; therefore, average out-of-pocket spending per person increased by 40%, going from MX$2,358 (US$138) in 2018 to MX$3,299 (US$193 )in 2020 (CIEP 2021). 

Healthcare was not delivered in these public institutions for many reasons: 24.8% of the cases were due to a lack of a doctor, 18.4% due to a closed unit, and 17.4% because they did not want to treat the patient.

These data clearly demonstrate that the public health system and the will to make access to health a right is not working in Mexico and is about to collapse. 

Possible Solution  

In my opinion, healthcare should be both a right and a privilege. 

On the one hand, healthcare should be a right for underserved people, due to factors including low income, a lack of work, disability, legal status (immigrant), among others. The government of each country should be responsible for providing them with healthcare through  public health policy programs. 

On the other hand, for the  group of people like workers, politicians, companies, among others, it should be a privilege. But the government has to help that group to have access to healthcare by forcing every company to provide a private healthcare solution to their workforce. The payment of that benefit should be 100% deductible to help companies lower their tax charges. And insurance policies should have minimum basic requirements to ensure companies provide decent and useful coverage. 

In that way, public healthcare will not collapse as it focuses on a particular group of people and private healthcare (private hospitals, insurance groups) will contribute to the increase of GDP. In my opinion, it is a win-win solution and a shared responsibility among the government, private sector and individuals to ensure constant and quality healthcare access.