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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