Insufficient resources, inappropriate allocation, and inadequate quality are major obstacles to the delivery of effective healthcare that reaches the poor. According to research done by Johns Hopkins School of Public Health, the lower-middle-income countries (LMICs) account for 90% of the global burden of disease but only 12% of global spending on health. There is not only a correlation between poverty and lack of accessible healthcare, but also causation.
Ideally, standards of health profoundly influence economic performances and quality of life. However, people in developing countries tend to have less access to health services than those in developed countries.
Healthcare Access in Developed and Developing Nations
The key difference between developed and developing countries lies in the fact that developed countries are self-sufficient and developed in terms of industries and economies while developing countries are not – or yet to be. The rate of unemployment and poverty causes a delay in receiving proper treatment, including healthcare access. When healthcare is needed but delayed, people’s health worsens.
Mainly, there are four dimensions of healthcare access that are discussed in developed and developing countries, each having a supply-and-demand element, and include the following:
- Accessibility – refers to the physical distance or travel time from the service delivery point to the user.
- Availability – having the right type of care available to those who need it, such as hours of operation and waiting times that meet demands of those who would use care, as well as having the appropriate type of service providers and materials.
- Affordability – refers to the relationship between the price of service and the willingness and ability of users to pay for those services.
- Acceptability – the match between how responsive health service providers are to the social and cultural expectations of individual users and communities.
In developed nations, such as member states of the European Union (EU), universal access is a fundamental feature of the healthcare system. This universal access is also incorporated into the EU Charter of Fundamental Rights as Article 35, whose first part reads ‘Everyone has the rights to access to preventive healthcare and the right to benefit from medical treatment under the condition established by national laws and practices.’
We can see one of the most prominent real cases in German. The healthcare system and access to receive health treatment have been made accessible in Germany, in which the country has consistently demonstrated a reduction in the cost of healthcare per capita relative to Germany’s GDP growth. The underlying system in this country proved to become highly effective, affordable and accessible to German citizens, as reported by the Institute for Quality and Efficiency in Healthcare, Germany in 2006.
Another example of a developed healthcare access is in Japan. Healthcare in Japan is provided free for all Japanese citizens, expatriates, and foreigners. Japan provides its entire population with equitable health insurance that guarantees ready access to virtually all medical facilities. This policy is based on a belief that if equity and universality of access are goals, then cross-subsidization of payments must occur between people of different economic means, and the government must regulate this process. Another exciting dimension of Japanese health care is the special health status of its 122 million citizens. According to the latest report by Japan’s Ministry of Health and Welfare, the infant mortality rate of 0.5 percent of live births (compared with the U.S. figure of 1 percent) places Japan in the top rank among industrialized countries. Japan’s average life expectancy at birth of 75.6 years for males and 81.4 years for females also ranks high among nations.
However, in many developing nations, a lack of resources contributes to adding difficulties for people to access healthcare. Resources can range from money to tools to infrastructure. According to research done by the University of Macedonia, many millions of people suffer and die from conditions for which there exist effective healthcare interventions. However, because of the underutilization of effective healthcare, there exist large unrealized health gains in developing countries. In 2003, Bellagio Child Survival Study Group explained that child deaths could be cut by 63% worldwide if coverage rates of effective prevention and treatment interventions were to increase to 99%.
Furthermore, in Bolivia, 60% of children who died during a study period were not taken for medical treatment during the fatal sickness episode, as reported on a mortality survey in Bolivia, in 1998. Due to a lack of resources, the substantial gaps that exist between the actual health spending of many developing countries and the spending required to provide a package of essential health services suggest that lack of availability is the root of the problem in many instances.
Let’s take a look at Southeast Asia. Shaped by its history, geography, and position as a major crossroads of trade, Southeast Asia is a region of vast social, economic, and political diversity. This has contributed to the disparate health status of the region’s various populations, as written by a United Nations University article in 2012.
According to Deloitte’s 2015 Healthcare Outlook, Thailand’s spending on healthcare is estimated at 3.3 percent of GDP in 2013, which is proportionately less than the Philippines, Malaysia, or Singapore, but more than Indonesia (at 2.8 percent in 2013). Indonesia, comparatively, has a very poor public healthcare system with only two doctors per 10,000 people. The country is suffering from severe infrastructural limitations with only 0.6 hospitals beds per 1,000 population. Myanmar spends the least on healthcare at 1.8 percent of GDP in 2013, according to the World Health Organisation (WHO).
Strategies To Improve Healthcare Access in Developing Countries
In order to raise the utilization of effective healthcare and improve access, it requires more money for healthcare. It requires reform of management, regulatory, as well as political mechanisms to deliver the best healthcare. According to research done by the University of Macedonia, the strategies are:
- Extending health insurance coverage
Financing healthcare through out-of-pocket payments strengthens the constraining effects of current income and price on utilization. Moreover, according to Organization for Economic Cooperation and Development/World Health Organization (OECD/WHO) DAC guidelines, the development of equitable financing through increasing pre-payment and risk pooling is one of four priorities for the development of a pro-poor health system delivering quality, accessible health services to the poor.
- Pro-poor price subsidies
This approach allows the public expenditure subsidy to be concentrated on those most in need financially, but also medically to the extent that poverty and ill health. In other words, this approach is to apply the fee waiver schemes, such as health cards, where the distribution and utilization will be focused on the poor. This scheme, however, has operated in Indonesia since 1997. The cards raise the utilization of outpatient care by the poor and cause both the poor and non-poor to substitute the public for private care.
- Lowering the barrier of distance
According to World Bank’s 2004 The Millennium Development Goals for Health, lowering the barrier of distance requires either taking people to service or service to people. This also includes the improved transport systems which will reduce the cost of reaching healthcare and raise the ratio of facilities to the area population. Transportation systems, road infrastructure, and geography influence the demand for care delivered by formal providers. In rural communities, where the roads are poor and transportation unreliable, the time spent waiting for transportation may be as great as—if not greater than—the time spent traveling to the facility.
In practice, supply and demand-side issues are not easily separated. If the available healthcare is poor, it is not surprising to find there is little demand for it. Limited resources are the root cause of providing inadequate access to healthcare in developing countries. The poor in developing countries suffer from a disproportionate burden of disease yet usually have less access to healthcare, whether measured by accessibility, availability, affordability, and acceptability.
There are many innovations in financing, service delivery, and regulation of care that hold promise for improving access for the poor. The same can be said of older strategies. In either case, the challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for and to ensure that information and incentives are aligned in ways that can demonstrate improvements in access by the poor.