INEQUITY IN THE HEALTH SYSTEM
Health from a political-legal view is seen as a right enforceable by the citizens of a country, assuming a right to physical integrity. Therefore, the State is forced to protect integrity when it is in danger. This right corresponds to the duty and the obligation to maintain it, recognized by all criminal codes, being a crime any act that threatens it. Attempting against health, own or others, is punishable by the State. This conception of health, extends through all latitudes and political systems and, although the varieties of its recognition as rights are different between various systems, there is a common universal consensus in the political-legal health conception that is recognized inThe Universal Declaration of Human Rights. However, health is a right or privilege? Is there really health equity for all? In this essay, the inequality in health will be evidenced. There will be talk of the socio -economic differences that exist within health systems, high prices in pharmaceutical products, the disparate distribution of financing between public and private sectors, gender inequality in health plans such as ISAPRE and finallyracism disseminated in health entities.
Health equity means, ideally, that everyone must have the right opportunity to achieve all their health potential and, more pragmatically, that no one should be at a disadvantage when reaching it, if this can be avoided.
In Latin America, public health systems are being demolished and promoting the privatization of services (following the policies and pressures of international financial organizations, especially the World Bank). These reforms (which follow neoliberal thought) have brought very negative results, with several countries showing significant setbacks in public health indicators. By privatizing services, those people who have a better economic situation are given priority, which at the same time have better living conditions, so their possibilities of getting sick are minor, since health-disease processes do not depend exclusively on thepeople, but of the interactions between the person and their surroundings. This favors the appearance of diseases and makes it difficult or facilitates that the sick person receive appropriate treatments, control their disease and recover. In this way, people with fewer resources and worse living conditions have more possibilities of getting sick and, in contrast, health systems and social public policies substantially influence this link between social inequalities and health. We must add to this that a patient who does not have payment capacity cannot receive treatment that he cannot pay, although these treatments are indicated in the clinical protocol. Thus the socioeconomic condition determines whether or not it will receive treatment or whether it will be a better or worse treatment.
Access to pharmaceutical products is also reduced, due to the high prices they have. The pharmaceutical industry has sold to the public the idea that innovation is stimulated by competition and that high prices guaranteed by patents are essential for financing. However, one more close look at the financial structure of the pharmaceutical sector shows that the highest expense is concentrated in marketing and not in research. Research projects, in reality they only make small improvements in clinical trials. But to achieve statistical relevance, these essays must be carried out in homogeneous populations with narrow inclusion criteria, a very expensive task. This cost then translates into higher prices. Market penetration with small medical improvements also requires a large marketing investment, another cost that is recovered with higher prices. The result is that we get increasingly expensive medications with less innovation and therefore less impact on health. In epidemiological terms, limited access to these expensive products also contributes to a minimum impact at the population level.
All this leads to a more inequality in health for socio -economic issues. If a person has cancer, medicines have exorbitant prices for a person who has a minimum salary, he could never pay for treatment or medicines, being in this way unfair, since a person who has the means to pay for him can live, inChange the one who does not have the media will have to wait for his death in the most painful way.
The distribution of financing between the public and private sector is inequitable in Chile. 38% of the total resources that the country occupies in health, are spent in 21% of the population that Isapre has and 62% of the resources are allocated to most of the population that is the remaining 79% (Fonasa). Since the contributions are associated with the income and segmentation of the population between public and private systems, 59% of the contributions go to the private sector and only 41% to the public sector, which compensates, in part, with the fiscal contribution. For health financing in Chile, they are the pocket expenses that represent 33% of the global health financing. Being 22% in Fonasa and 33% in Isapre. On the other hand, those who do not have coverage must virtually cancel all costs. Drug spending is the most important item, and represents 44% of the total pocket -financing and 12% of the total financing of Isapre and Fonasa. By excluding expenses not associated with the production of medical benefits, pocket expenditure indicators increase (up to 43% in Isapre), while financial responsibility for health care insurance decreases, in particular inThe private sector.
Gender equity in the field of health will be equitable if both men and women have equal access to public and private health resources, according to their needs and not according to their gender or socioeconomic position. However, this is not so in the Chilean health system, plans in Isapre are much higher in women than in men. The biggest difference in the cost of health plans by sex occurs in the age range between 18 and 44 years, in which women pay more than double than men, due to the reproductive age, associating the cost of motherhoodexclusively to women. However, if maternity costs are excluded, on average, they are loaded with 107% compared to the price charged to men by the same health plan. These pricing differences by sex would be attributed by ISAPRE that women make a more frequent use of health benefits and medical licenses. This means that when a woman hires a health plan, the Isapre presumes that, without counting maternity benefits, that woman will use the health benefits of her plan, on average, more than double what a man would do so. In addition, it must be added that there are another series of cultural factors that discriminate against women in relation to men (gender discrimination), which translates into lower salary income, and therefore, a lower payment capacity, thanThey put it in a disadvantage position regarding man in access to private insurance
With respect to racism in health entities, there are recent studies in the United States demonstrating that, despite protocols, racial differences translate into a type of discrimination through which health professionals offer inappropriate treatments or less therapeutic alternatives toPeople belonging to racial minorities, even after controlling by socioeconomic situation, diagnosis and type of health insurance. That is, two patients, one black and one white, with the same clinical picture, gender, age and with the same payment capacity, receive different treatments in the United States, one considered inappropriate and another suitable. This is explained by analyzing the culture of health in the West and the relations between social inequalities, races and privileges, which have produced a biased look at health professionals that leads them to offer inappropriate treatments to people of racial minorities.
Finally, socioeconomic inequality makes it impossible for you to obtain a better service in health systems, prevents you from accessing medicines with exorbitant prices, forces you to pay a high health plan such as ISAPRE or a low one as FonasIt does not have the best health care and with less coverage. In addition, gender inequalities, where for just being a woman they charge you much more compared to men. Racism, which is widely disseminated in many countries, is strongly involved in health care.
Health is not a right and is not equitable for all. Public policies are needed that can solve these problems, inequalities occur due to differentiated operation schemes from the private and public sector, selection and segmentation processes due to the risk and income of the population. To reduce them, it is necessary to encourage the existence of mechanisms that promote solidarity between systems and financial protection in them, central aspects for redistribution and effective equity in financing to access health care.
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