This year’s health care reform bill has been a hot button issue in the United States, so it is very relevant that the past weeks readings discussed the issue of health care fees and coverage. While the articles discussed how low income families in developing countries can barely afford health care services, the same problem, to an obvious lesser extent, is happening in the United States. There were many statistics that shocked me when reading the various articles, one of them being that a majority of people in developing countries generally skip primary care facilities that are closer to their home, choosing instead to seek out care at governmental or private hospitals. This was most surprising to me since not only are private facilities more expensive, but studies have shown that 25.9% of households in low income countries either borrow money or sell items to pay for their health care. This can be attributed back to the fact that in these developing countries, 70% of health financing comes from out of pocket.
When I read this, my first thought was “why would a country whose citizens can barely afford food and water make receiving health care nearly impossible?”. The paying out of pocket system barely works in highly developed and wealthy countries such as the United States. In fact, in the United States, 41% of non elderly have accumulated health care debt and of that percentage 60% had health insurance. Receiving adequate health care in the United States is so expensive that many in the lower income bracket acquire huge debt or skip necessary treatments all together. According to one study, these exact actions are also highly prevalent in countries in Africa and South East Asia. This is frightening to me, that the United States health care system so closely resembles those which have some of the highest mortality ad morbidity rates in the world. While of course there is a large difference in those actual rates between the two geographic regions, the fact that people skip treatment that could save their lives because it is too costly is not only worrisome, but shows the disparities of health access in this country.
There are two pertinent questions that should be asked here; why is it that people are choosing not to get adequate treatment, and why are the poor paying so much money for health care? Perhaps it is because in 1987 the WHO released a report which said that if low income countries in Africa implemented user generated fee’s not only would there be an improvement in health care outcomes but there would be additional revenues. One of the main arguments used to support this new out of pocket policy was that it would improve access of health to the poor. Many of you are probably wondering how would making people pay more money for procedures they already cannot afford increase their incentive to seek medical aid. Well, just as I have discussed in the paragraph above, it doesn’t and this was confirmed in a follow up report done in 2000 by the WHO. In fact, a reported three million child deaths in the last twenty years would have been averted if user fees were not the policy in those countries. Since then many countries have reversed this impractical and inefficient policy but there is still much to do before this issue is resolved. While there is no clear cut solution to solve the many problems I have just discussed, that policy makers are realizing some of their mistakes and acknowledging that things must be changed is a step in the right direction.