Tuesday, January 12, 2010

The "Right To Health" In Brazil

The London-based International Policy Network recently published an interesting essay by Jacob Mchangama (a Copenhagen lawyer) entitled, "Health as a human right: the wrong prescription".

Mchangama summarizes some of the legal theories used around the globe to allegedly justify the concept of a "right" to health and health care.

I was particular struck by his discussion of how this plays out in Brazil:
...Brazil's constitution explicitly recognises the right to health, but many patients who call upon the state to fulfill this obligation are frequently met with shortages and stockouts in state pharmacies.

Many of these patients have therefore -- quite reasonably -- responded by suing the government. The right to health has therefore led to an explosion of judicial challenges by patients against the government, with more than 1200 cases of judicial review sought in the Rio Grande do Sul region alone each month.

Such claims act as a major burden on the judicial system as well as a heavy fiscal burden on the government.

There are also severe ramifications for equity. Rather than making access to healthcare universal, in Brazil the enforceable right to health has had the perverse consequence of favouring the politically connected or those who can afford the high cost of judicial review.
(From page 12 of "Health as a human right: the wrong prescription".)

As Mchangama puts it in the executive summary:
Turning healthcare into an individual enforceable right creates all kinds of legal complexities, undermines the rule of law and stifles political pluralism. Neither is there any evidence that "the right to health" has actually improved healthcare anywhere in the world -- in some cases it has undermined it.

In reality, the rights which are really fundamental to improved healthcare are those which underpin prosperity and economic development -- such as the right to own and exchange property. Such rights are denied to millions, yet are vital for creating the prosperity needed to pay for good healthcare.
(Note: I don't know anything about the IPN other than what I've seen in this article. But I'm glad ideas like these are being discussed at the international level.)