Achieving Timely and Appropriate Healthcare as a Right
In their handbook, the Sphere Project (2018) make the bold assertion that everyone has a right to “timely and appropriate healthcare” (p.292). the Sphere Project identify this right as an essential concept of healthcare, especially in humanitarian contexts. However, shouldn’t this assertion not be the standard for healthcare systems? This essay argues that indeed timely and appropriate healthcare should be a right for all individuals. The goal of policy makers in healthcare should be to putting place innovative policies that move the healthcare system towards achieving the status of being to uphold the identified right.
To highlight the need for having timely and appropriate healthcare as a right, it is necessary to look at the current healthcare system in the U.S. While healthcare expenditure per capita is higher in the US than in all other developed countries, the country has failed to guarantee healthcare to its population (Mitra, 2018). In fact, based on data collected in 2018, about 8.5% of the US population (approximately 27.5 million Americans) do not have any form of health insurance (Berchick, Barnett, & Upton , 2019). This means that this section of the population does not have no access to healthcare. At the same time, there is also a growing number of individuals who are underinsured, and as such have to make significant payments in form of deductibles and out-of-pocket expenses (The Commonwealth Fund, 2019). While the uninsured might not access healthcare at all when they need it, the underinsured are often forced to delay healthcare due to financial constraints. In fact, approximately 42% of underinsured adults are forced to delay receiving healthcare that they need due to financial constraints (The Commonwealth Fund, 2019). However, in both cases – being uninsured and being underinsured – the ability to access timely healthcare is limited. Similar issues with access to healthcare exist around the world.
The Agency for Healthcare Research and Quality [AHRQ] (2018) identifies timely healthcare as one of the six aims for the healthcare system. The AHRQ (2018) defines timely healthcare as one in which waits and delays for those who are receiving and those who are providing care are reduced. The other five domains of healthcare quality as identified by AHRQ are being safe, efficient, effective, patient-centered and equitable. Some of these aims such as safety, effectiveness and being patient-centered directly relate to the goal of healthcare being appropriate. As noted by the AHRQ, a lot of focus has been placed on certain elements of healthcare such as effectiveness and safety, which has made the US healthcare system to be unequitable and not timely.
To correct this problem, government action is certainly necessary. While some policy makers have in the past argued that it is only through competition that the costs of healthcare can come down, they certainly do not offer a guarantee that costs would come down enough for everyone to access healthcare as they have access to any other right. It is the proposal herein that in order for the US to guarantee individuals access to timely and appropriate healthcare as a right, the US should model its healthcare system around an already existing and relatively successful healthcare system within the larger healthcare system – the Veterans Affairs system.
Instead of pouring money into government funding of healthcare through programs such as Medicare and Medicaid, the government should seek to establish its own network of healthcare facilities, that would be managed by the department of health and human services (HHS), like the department of veterans’ affairs has. Within these healthcare facilities, primary healthcare such as treatment for basic illnesses, management of chronic diseases and disease prevention services should be freely available to the public. Appropriate healthcare can be delivered by adopting the VA’s qualities. For instance, the VA emphasizes on bringing comprehensive expertise together and maintaining an interconnected service system that affords patients access to the professionals they need who are within the VA healthcare system (Shulkin, 2016). The VA also ensures that delivery of care is personalized, patient-driven and pro-active (Shulkin, 2016). Therefore, attaining appropriate healthcare is achievable.
However, timeliness of healthcare is often viewed as impossible to guarantee in a healthcare system where access to healthcare is universal (which occurs when healthcare is regarded as a right). Timeliness of healthcare is however quite important, especially in emergency situations. In the proposed system, timeliness can be enhanced by ensuring competition and collaboration between the public health care system and the private healthcare system. Having a government-funded network of healthcare systems would certainly offer competition to private facilities which would eventually be forced to lower costs.
Lower costs in the broader system would mean that not all individuals have to be attended by the public healthcare system. The private healthcare system would also offer access to expensive procedures that government facilities would have limited capability to provide. Therefore, maintaining a private healthcare system alongside the public one, with the two as competing forces, would enhance the timeliness of healthcare. However, primary healthcare services (as described herein) should be viewed as the basic minimum. Therefore, when the government cannot provide these services at its facilities, it should collaborate with private facilities by reimbursing for such services when they are offered to member of the public in private healthcare facilities. The VA has for instance set appropriate maximum geographical distances and wait times that veterans have to deal with (Farmer & Tanielian, 2019). If these limits are exceeded, then an individual can access healthcare in a private institution, with the VA bearing the costs of such care. This approach ensures that individuals who need healthcare access it in a timely manner.
In conclusion, it is clear that under the current system, timely and appropriate healthcare is not accessible as a right. To change this, it is necessary for the government to make more direct investments in healthcare instead of focusing on reimbursing healthcare providers. A healthcare system like that adopted by the Veterans Affairs Administration (which is achievable and has proven to be effective) should act as a good framework for developing a healthcare system that is able to deliver timely and appropriate healthcare as a right, to all individuals in the US and around the word..
References
Agency for Healthcare Research and Quality. (2018, November). Six domains of health care quality. Retrieved July 2, 2020, from Agency for Healthcare Research and Quality website: http://www.ahrq.gov/talkingquality/measures/six-domains.html
Berchick, E. R., Barnett, essica C., & Upton , R. D. (2019, November 8). Health insurance coverage in the united states: 2018. Retrieved July 2, 2020, from The United States Census Bureau website: https://www.census.gov/library/publications/2019/demo/p60-267.html
Farmer, C., & Tanielian, T. (2019). Ensuring access to timely, high-quality health care for veterans: Insights from RAND research. https://doi.org/10.7249/CT508
Mitra, M. (2018). Free universal health care system in United States. Sociology International Journal, 2(6). https://doi.org/10.15406/sij.2018.02.00137
Shulkin, D. J. (2016). Why va health care is different. Federal Practitioner: For the Health Care Professionals of the VA, DoD, and PHS, 33(5), 9–11.
Sphere Project. (2018). The sphere handbook: Humanitarian charter and minimum standards in humanitarian response (4th ed.). Geneva, Switzerland: Sphere Association.
The Commonwealth Fund. (2019, February 7). Underinsured rate rose from 2014-2018, with greatest growth among people in employer health plans. Retrieved July 2, 2020, from The Commonwealth Fund website: https://www.commonwealthfund.org/press-release/2019/underinsured-rate-rose-2014-2018-greatest-growth-among-people-employer-health