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ARIN BASU

SONGSOPTOK THE WRITERS BLOG | 4/15/2016 |




SONGSOPTOK
INTERVIEW WITH ARIN
HEALTHCARE A RIGHT OR A PRIVILEGE?


SONGSOPTOK: Do you consider primary healthcare to be a fundamental right? Is it deemed as such in the society you live in? Please explain your answer with a few examples if possible.

ARIN BASU:  When we say Healthcare is a right, what we mean access to health care is a right. In this sense, everyone should be equal in an ideal world when it comes to accessing health care, and more importantly, good quality health care. Thus, when you consider right to health care in a just and equal world, you will see that people who are genuinely sick and really need urgent care, they are the ones who get the care first, not necessarily those with money and fame or those who are socially privileged should receive care ahead of another person whose life could have been saved.


SONGSOPTOK:     What is the system of healthcare in the country and the society you live in? Is it a just and equitable system in the sense that all citizens enjoy the same benefits across economic and social classes?

ARIN BASU:  In New Zealand, we have socialised health care, which means the government covers for the health care costs of the residents, in turn covered by the taxes.


SONGSOPTOK:     Do you think that free healthcare cannot be a right, but it can be a privilege and a shared burden of sacrifice for the sake of the social contract?

ARIN BASU: There is no such thing as “free healthcare”, for the same reason there is no such thing as free lunch. Someone is paying for the cost of the health care. That “someone” could be the government, or could be an insurance agency (if government is not the insurer). What is desirable is that people should get highest possible quality of health care at the lowest possible cost to them (in terms of money and time), and that access to health care for everyone should be universal. This is an ideal scenario, but usually people have to choose two out of any three of them.


SONGSOPTOK:     What, in your opinion, should be the role of the government for ensuring equal healthcare to all citizens? What role is played by the government of the country you live in?

ARIN BASU: The word equal healthcare is a myth and government cannot ensure it unless it is a “Nanny State”, but a nanny state would not be an ideal situation as one would also prefer that in certain areas the Government should stay out. For many people, obtaining health services at certain times and places are based on their own free will, as also what form of health services would they like to avail of. In many of these situations, it would not be prudent for a government to step in and dictate what, where, and how people should access health services.


SONGSOPTOK:     According to the data published by World Health Organization (WHO), nearly 16 000 children under the age of 5 die every day in the world (5.9 million in 2015) from infectious, neonatal or nutritional conditions. Is this a reality in the country you live in? If so, what would your suggestions of improvement be?

ARIN BASU:  No.


SONGSOPTOK:     “Free access to healthcare is a fundamental human right. Access to free healthcare is not” – do you agree with this statement? Please explain your choice.

ARIN BASU:  Yes, see my response to question “four”.


SONGSOPTOK:     How important is the role of the private sector for providing healthcare and related facilities in your country? What it is your opinion about it?

ARIN BASU:  Very little. In a just society, private sector will have very little role in delivering health care compared with the social governance structure that ensures that people should have opportunity to lead healthy lives, and when they fall ill, there should be remedial services available at the most opportune time.


SONGSOPTOK:     Are charitable and Non-Governmental Organizations (NGO) active in the domain of public health? If yes, then in what spheres? Do you think that the civil society, either independently or through these organizations, should become the prime actor for ensuring healthcare for all?

ARIN BASU:  Yes. Several intergovernmental agencies are also active.


SONGSOPTOK:     Do you think that multinational pharmaceutical and healthcare companies are responsible, to a certain extent, for the widely variable quality of healthcare in different countries? Can you please illustrate your reply with some examples?

ARIN BASU:  It needs to be emphasised that healthcare does not necessarily result in health, it is about resolution of illnesses. So, while testing the hypothesis that multinational pharmaceutical companies are responsible for variable quality of healthcare, we need to consider what actually are we measuring here. In the literature on quality assurance of healthcare, structure, processes, and outcomes are discussed. Structure of the healthcare refers to the mix of healthcare providers, the places where healthcare provision occur, the facilities, the mix of specialisation (primary versus secondary versus tertiary care providers: primary care providers are general practitioners, nurses who practice, other alternative health care providers; the term secondary and tertiary health care provides refer to specialists and superspecialists). The process of healthcare refers to the steps taken to provide health benefits to the people. This starts from the provision of healthful environment (easy affordable availability of vegetables, high grade proteins, parks and recreation, facilities that are relatively free of pollution, opportunity to live productive life, and so on: question is, who will provide this? The person for himself or herself, the society, the government, the other sectors that can help?); then, there is the process of actual healthcare; this refers to the knowledgable medical caregiver, the nurses, the level of training of the caregivers, the availability of evidence based healthcare, and adherence to the evidence base, availability of clinical and non-clinical healthcare practice guidelines, checks and balances from the government or the regulatory authority to enforce that such guidelines are adhered to (failing which there is provision of reparation or justice). The third entity in the evaluation of quality of healthcare is the outcome: are people getting “better” as a result of accessing health services and receiving health services? Judged from this perspective, global corporations can play some, but not a decisive role in the variability of the quality of care. Sometimes, they do influence the provision of care. For example, in 2009, Roche marketed Tamiflu to the World Health Organisation and several other countries and this led to stockpiling of the drug in anticipation of an impending Flu outbreak that never happened, and no one (at least Roche did not) release their evidence base for greater scrutiny on the effectiveness and harm profiles of “Tamiflu”. Despite availability of the evidence to the contrary about its effectiveness (from a meta analysis by Tom Jefferson and colleagues published in Cochrane review), several governments in the world went ahead to stockpile the medications and it was not only wasteful, but the harms that could have been avoided nevertheless occurred. A moral of stories like this highlights the fact that not just global companies, there is an interdependency between companies, but also governments and intergovernmental agencies, so just considering the role of global companies alone is simplistic for what is essentially a systemic issue.


SONGSOPTOK:     Do you think that adopting the Social Security model implemented in a lot of countries in Europe which ensures primary health coverage to all citizens and is financed by the totality of the working population can be relevant and efficient in all countries?

ARIN BASU:  No, as each country and each system is different. To some extent, having the government and the society as primary insurers will incentivise that healthcare is better regulated, but at what cost in terms of time and efficiency needs to be careful considered.


We sincerely thank you for your time and hope we shall have your continued support.
Aparajita Sen
(Editor: Songsoptok)

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