Contrato de seguro marítimo

Achieving universal health coverage is defined by the WHO as “ensuring that all people can access the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship” (WHO, 2017). The provision of universal health coverage is based on the protection of the human right to health which was explored in detail earlier in Chapter 3. The process of approaching the protection of health as a human right integrates three distinct concepts: (1) universality; (2) equity; and (3) comprehensiveness (De Negri Filho, 2008). This means that the acceptance of the right to health entails an ethical position that disapproves of societies in which health systems fail to provide comprehensive and equal access to

basic health care facilities for all. A threshold right of access to health care – such as free aid in emergency situations – is argued to be a moral obligation upon those providing health services in order to respect the dignity and autonomy of each member and every part of the population (Menzel, 2011 and Giesen, 1994).

The provision of universal health coverage has been achieved by most developed countries, particularly for their own citizens (WHO, 2014), and is currently being advocated by the global health community as an essential future health goal for all countries (Clark, 2014). Universal coverage, if achieved, brings the hope for better health and protection from poverty caused or exacerbated by ill health for hundreds of millions of people, especially those in the most vulnerable situations, such as some immigrant populations.

The motivation of the state is the main critical factor for the establishment or not of universal health coverage. Szreter and Woolcock (2004) have recognised three main motives for the state to provide care to various social groups (including immigrants): the first factor derives from the constitutional sense of the ways in which the state does or does not underwrite equally the health needs and entitlements to health care for all residents, regardless of gender, age, ethnicity and creed; the second lies in the moral sense of the positive or negative disposition of people towards the collective protection of the population of which they form a part; and the third consists of the role of the state as the appropriate public arbiter and redistributor of the collective public resources.

In order to estimate the extent of the population’s health care coverage, the WHO has devised an explanatory framework which includes three dimensions: (1) population (which people are entitled?); (2) services (which services are provided?); and (3) costs (which costs are covered?). These parameters are presented schematically below in Figure 6.2. Guinto and colleagues (2015) suggest that the question of whether immigrants are considered enrolled and covered falls under all of these three dimensions:

Figure 6.2: The Three Dimensions of the Parameters towards Universal Coverage

Source: WHO, 2010

Even health systems with full coverage for all residents in a country do not always secure sufficient access for immigrants to health services because immigrant populations – especially persons with unauthorised presence – even if they are allowed to access health care, are usually subjected to complicated and strict procedures of scrutiny. However, tax-based national health systems may allow for wider access to care for the various categories of immigrants in comparison with other systems. In social security-based health systems, proof of insurance must be presented, impeding access for uninsured or illegal immigrants. Ironically, it has been argued that health systems operating under private initiatives can often be deemed better for immigrants, especially undocumented ones, because these systems are often able to accommodate patients with less administrative visibility, although financial barriers can prevent their access to private care (Castañeda, 2010).

Despite the wide acceptance of the importance of the human right to health, much work still needs to be done for the achievement of universal health coverage because weak political commitments, lack of institutional and financial resources and global economic interests may pose limitations (Chapman, 2009). The framing of health as a universal right, like all human rights, imposes three obligations on states (see Yamin, 2008 and Gostin, 2001). Firstly, states must respect this right and refrain from actions that interfere with its enjoyment. Secondly, they must act protectively by taking measures to prevent individuals and businesses from interfering with the right to health.

Thirdly, states must fulfil the right by facilitating and promoting a fair access to health care. Health professionals are also responsible in three ways (London, 2008). A health professional has to guard the operation of health systems and report any violation of the right to health. Moreover, he/she is obliged to work without any discrimination against individuals on the basis of race, gender, religion or other personal characteristics. Finally, human rights in general must be viewed as an essential part of one’s professional conduct. After all, the reliance on ethical frameworks as guidance for health professionals has a limited effect, despite the plethora of international statements and agreements, unless health workers are morally devoted to protecting people’s right to health (Rubenstein and London, 1998).

Although the establishment of universal health coverage is an institutional issue and the accountability of its preservation is mainly a task of governments and societies, health professionals constitute a valuable element in implementing it and monitoring potential violations. Importantly for the present study, the promotion (or not) of equity in health care is regulated mainly by political orientations and governmental decisions (Greer and Méndez, 2015) and thus the relevant theories mainly refer to the macro-level of health care. However, theories about equity in care also provide explanations relevant in the meso- and micro-levels, especially in the public health care sector where the operation of health services and health workers’ professional ethics and practice are largely driven by concepts of equity in health care.