Post on 02-Jun-2018
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THE RIGHT TO HEALTH
ANDDISTRIBUTIVE JUSTICE
IN HEALTH CARE
Ade Firmansyah S, MD
DEPARTMENT OF FORENSIC MEDICINE AND MEDICOLEGAL
FACULTY OF MEDICINE UNIVERSITY OF INDONESIA
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Scope of Study
The Right to Health
The Theory of Justice
The Finiteness of Health Care Resources Decent Minimum of Health Care
Ethics of Rationing
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What would you do?
NEEDS RESOURCES
Market system will increase the price, thus creating lesser demand
to balance need-supply, creating group of people who could get the
resources based on the ability to pay.
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Determining Needs & Resources
Needs
ICU Organ transplants
Hemodialysis
Surgery
Ward
Emergency care
Ambulance
Etc.
Resources
Men
Doctors
Nurses
Money
Government, private insurance, ownmoney
Method
Diagnostic, therapy, rehabilitation
Tools
ER, ICU, Ward
Surgery equipment
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What makes health special?
Norman Daniel:
Diseases and disabilities diminish peoples
normal species functioning and thus restrict the
range of opportunities open to them.
General Comment No.14, ICESCR
Health is fundamental prequisite to theenjoyment of other human rights
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Everyone has the right to a standard of living
adequate for the health and well-being of
himself and of his family, including food,
clothing, housing and medical care and
necessary social services, and the right to
security in the event of unemployment,
sickness, disability, widowhood, old age orother lack of livelihood in circumstances
beyond his control. (UDHR)
Definition of Health
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Vulnerable and marginalizedgroups in societies tend tobear an undue proportion ofhealth problems.
Overt or implicit
discrimination violates afundamental human rightsprinciple and often lies at theroot of poor health status.
In practice, discrimination canmanifest itself in inadequately
targeted health programmesand restricted access to healthservices.
Discrimination manifests itself ina complex variety of ways, which
may directly or indirectly, impact
upon health.
For example, the Declaration
on the Elimination of Violenceagainst Women recognizes
the link between violence
against women and the
historically unequal power
relations between men andwomen
Principal of Free from discrimination
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The right to health does not mean the right to behealthy, nor does it mean that poor governmentsmust put in place expensive health services for whichthey have no resources. But it does require
governments and public authorities to put in placepolicies and action plans which will lead to availableand accessible health care for all in the shortestpossible time. To ensure that this happens is thechallenge facing both the human rights community
and public health professionals. United Nations High Commissioner for Human Rights,
Mary Robinson
The Right to Health
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The Right to Health
Not only developing
comprehensive health care
facilities.
Including the fulfillment of
underlying determinants of
health: food, housing,
sanitation, clean water, etc.
THE RIGHTS TO HEALTH
UNDERLYING
DETERMINANTS
HEALTH CARE
Govern by Ministry of Health
Govern by Ministry of
Health, Education,
Environment, Labor, etc.
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Connection between Health and
Human Rights
Torture and lack of respect to human rightswill be resulted in serious health condition.
Health policy and regulation will further or
lower the human rights, depending on itsdesign and implementation.
Vulnerable society are tend to have lower
health status which could be reduced throughrespecting, protecting, and fulfilling humanrights.
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Information: Freedom to seek, receive and impartinformation and ideas of all kinds.
Privacy: No one shall be subjected to arbitrary orunlawful interference with his privacy.
Scientific progress: The right of everyone to enjoy thebenefits of scientific progress and its applications.
Education: The right to education,(14) includingaccess to education in support of basic knowledge ofchild health and nutrition, the advantages of breast-feeding, hygiene and environmental sanitation and theprevention of accidents.
Elements of Right to Health
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Food and nutrition: The right of everyone toadequate food and the fundamental right ofeveryone to be free from hunger.
Standard of living: Everyone has the right toan adequate standard of living, includingadequate food, clothing, housing, and medicalcare and necessary social services.
Right to social security: The right of everyoneto social security, including social insurance.
Elements of Right to Health
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State Obligation
To Respect :State obligation to developregulation which allow citizen to receivehealth care and prevent any restriction.
To Protect : state obligation to ensuring equalaccess to health care services.
To Fulfill: state obligation to ensuring the
rights of all citizen, especially those who arevulnerable to receive health care.
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Health facilities, goods and serviceshave to be accessible to everyonewithout discrimination
Health facilities, goods andservices must be scientifically andmedically appropriate and ofgood quality
All health facilities, goods andservices must be respectful ofmedical ethics and culturallyappropriate, sensitive to genderand life-cycle requirements
Functioning public health andhealth-care facilities, goods andservices, as well as programmes,have to be available in sufficientquantity
Availability Acceptability
AccessibilityQuality
Evaluating the Right to Health
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THEORY OF JUSTICELIBERTARIAN
Benefits and
burdens ofsociety are
distributedthrough
exercise ofrights of non-
interference
EGALITARIAN
Equal rights for
all Equal benefits
and burdens
UTILITARIAN
A just
distribution isone that
maximise sumhappiness
DISTRIBUTIVE
Fair
distribution ofbenefits and
burdens,advantage and
disadvantage
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Egalitarianism
People
right
People
right
People
right
People
right
Equal intrinsic right for every people, regardless their race, sex, social and economic
status.
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Utilitarianism
People
happiness
People
happiness
People
happiness
Sum
happiness
Utility: happiness and Sadness. Maximizing sum happiness as goal. Not counting
personal happiness as long as sum happiness is maximum.
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Rawls Distributive Justice
Every person are entitled to :
Fair equality of liberty
Fair equality of opportunity
Difference principle :
If the distribution of goods and services are
unequal, those who are vulnerable should benefit
the most
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Rawls Distributive Justice
Liberty
Economic status grants its
bearer liberty to choose
what kind of health careservices needed.
Place grants its bearer
liberty to choose where
they want to get services
Opportunity
Economic status grants
opportunity to receive any
services needed. Place grants people
opportunity to go to any
institutions for health care
services.
People whose low on liberty and opportunity are regarded as vulnerable. Thus
creating obligation for state to leverage their liberty and opportunityDifference
Principle
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The Goals of Health Care
Preventive
Curative
Rehabilitative
Immunization
Profilaxis drugs
Surgery
Medicine
Rehab medicine
Supportive therapy
To preserve the range of opportunities we would have, were not
ill or disabled, given out talents and skills.
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The entitlement theory
People are entitled to right to health
Right for someone, impose duties to others to
provide
Duties not to interfere with that persons
obtaining something
Duties to help person in their efforts to get
something
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What kind of entitlement?
Daniels: normal peoples functioning
Right to a good minimally functioning humans life
Right to a decent minimum health care
Decent minimum health care means preserve life
Everyone would have access to minimal basic
array of health care resources.
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Two Tier Health Care Services
Decent minimum
Preserve life
Prevent death
Advanced
Elective
Non-essential therapy
Health care that provide a decent minimum life should be universally available,
publicly supported, guaranteed.
Secont tier of additional health care services would be available in the free
marketplace for those who can afford them.
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Decent Minimum
Not all health care is of equal importance
Allocational priorities must be set witthin health
care
Right to health is not unlimited
Resources must be allocated not only to health
care
Decent minimum is a floor in which no oneshould be allowed to fall below it
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Ethics of Rationing
Who should get what share of limited health
care goods and services?
What criteria should be used?
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Ethics of Rationing
John F. Kilner:
Social criteria
Socio-medical criteria
Quality of life
Medical criteria
Prognosis
Imminent death
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Ethics of Rationing
Utilitarian approach to rationingQuality
Adjusted Life Years (QALY)
Measure objectively the benefits that a treatment
is likely to give each patient.
Selectively treat particular patients or conditions
to maximize total benefits.
One QALY is equivalent to one yea of life in goodhealth, and a year of life in poor health is equal to
less than 1 QALY.
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National Security Assurance
JKN
BPJS
Kesehatan
BPJS
Tenaga
Kerja
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selalu_ada_ade@yahoo.com
Jakarta, 2014
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