Do we need a world health insurance to realize the right to health?

There has been growing recognition in the international community that health should be considered a human right, but much less attention has been paid to the ensuing legal obligation to provide international assistance, says a team of authors from Médecins Sans Frontières, led by Gorik Oooms.

There are two major reasons, say the authors, why many countries get out of their obligation to provide such health assistance.

The first reason is the idea of shared responsibility. "Poor states can blame rich states for not honouring their obligation to provide assistance, thus leaving poor states with insufficient means to meet their core obligations," say Ooms and colleagues. "Rich states can blame poor states--and each other--for not doing enough."

The second reason is the notion of "progressive realization," i.e. the recognition that economic, social, and cultural rights cannot be fully realized in a short period of time. "This allows states to claim that they are doing or have done everything they can," say the authors.

Ooms and colleagues say that a "world health insurance" could solve both of these problems by defining rights a nd duties for both rich and poor states.

As a model for how such an insurance scheme might operate, they cite the example of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The creation of the Global Fund, they say, "demonstrates the merits of ambitious thinking: the provision of antiretroviral therapy to people living with AIDS, previously dismissed as unsustainable, became widely accepted as soon as the Global Fund provided a long-term funding perspective. Other health interventions deserve a similar approach."

Ooms and colleagues' framework for a world health insurance involves rich states paying a fair contribution and poor states having the right to assistance according to the health-care needs that they are unable to finance themselves. The WHO has estimated that a state needs to spend at least $35 per person per year to finance adequate levels of health care. Under Ooms and colleagues' sc heme, rich countries would have an obligation to assist those countries that are unable to reach this spending on their own.

"Our article is an exercise to show that it is possible to implement the obligation to provide assistance, and that this would change the debates about sustainability," commented Ooms.

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Citation: Ooms G, Derderian K, Melody D (2006) Do we need a world health insurance to realise the right to health? PLoS Med 3(12): e530.

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