https://orcid.org/0000-0001-9969-9955
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ABSTRACT
The first National Health Service (NHS) was introduced in the United Kingdom providing free universal health care (UHC) at the point of use. Within decades, increasing European countries adopted the same intervention to improve the health of citizens on the entire life span. Today, several reasons put at risk (1) empirically, the sustainability and fairness of these systems, (2) theoretically, the same consistency of solidarity, as vulnerable patients struggle most to receive essential care. Preserving solidarity from the pressure of modern medicine and society needs to identify a fair and sustainable type of coverage at the same time. This paper aims (1) to describe the short circuit of solidarity in European NHSs; (2) to discuss alternative versions of UHC and support redistributive neo-universalism; (3) to promote the role of medical humanities in implementing this solution.
Disclosure Statement
No potential conflict of interest was reported by the author(s).
Notes
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2 Ibid., 41.
3 Porter, The Cambridge Illustrated History of Medicine, 48, 310–311, 376.
4 Daniels, Just Health, 14–16; 145–147.
5 Tudor Hart, The inverse care law.
6 Watt, The inverse care law today.
7 Lawless et al., What does integrated care mean?; Fosti et al., Il Welfare e la Long Term Care in Europa.
8 European Commission, Defining Value in “Value-Based Healthcare”.
9 As of January 31, 2020, Great Britain no longer belongs to the European Union. However, the author believes that Brexit does not compromise the consistency of the paper analysis: first because Brexit did not change the local health care system; second because the data here mentioned are prior to that moment.
10 “Ssn. Sostenibilità e compatibilità: due concetti da distinguere con chiarezza.” Quotidiano Sanità, May 29, 2014; Italian Constitutional Court, Sentence n. 304/1994.
11 Organization for Economic Cooperation and Development (OECD), Health at a Glance: Europe 2016, 198–199.
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15 Kluytmans et al., Early Assessment of Health Innovation.
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18 Rao et al., The overuse of diagnostic imaging; O’Sullivan et al., Temporal trends in use of tests in UK primary care.
19 O’Sullivan et al., Temporal trends in use of tests in UK primary care.
20 Fondazione Gimbe, IV Rapporto sulla Sostenibilità del SSN, III.
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23 OECD, Tackling Wasteful Spending on Health; McNulty et al., The English antibiotic awareness campaigns.
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26 Smith, The NHS: Possibilities for the endgame.
27 Fondazione Gimbe, IV Rapporto sulla Sostenibilità del SSN, II, 3, 63
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29 WHO, Constitution of the WHO.
30 Fondazione Gimbe, III Rapporto sulla Sostenibilità del SSN.
31 Fondazione Gimbe, IV Rapporto sulla Sostenibilitò del SSN, II, 3, 63
32 Toth, op.cit.
33 Consorzio per la Ricerca Economica Applicata in Sanità (CREA), Unequal Universalism, 30.
34 Ibid.
35 OECD, Health at a Glance 2021, 13–14.
36 Lawless et al., op.cit.
37 WHO, Universal Health Coverage. https://www.who.int/health-topics/universal-health-coverage#tab=tab_1.
38 Säfström et al., op. cit.
39 Bognar et al., The Ethics of Health Care Rationing; Daniels, op.cit.
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41 Fosti et al., op.cit.
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44 Daniels, op. cit.
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47 Martha Nussbaum shares with Amartya Sen the idea that a just society has priority to protect the most relevant personal abilities, initially defined through an objective theory of the good life (Nussbaum, Non-relative virtues; Nussbaum et al., The Quality of Life, 46–48), and more recently revised from a more inclusive, multicultural perspective (Nussbaum, Giustizia sociale e dignità umana). See also Schramme, op. cit.
48 Schramme, op. cit.
49 Pennestrì, Procreazione eterologa medicalmente assistita in Italia.
50 Catastrophic out-of-pocket expenditure is a common reason why patients end up in choosing whether to eat or receive care (i.e., losing psychophysical function and job because of a road accident or a incurable cancer diagnosis).
51 Shares are generally calculated automatically by the provider based on ready-to-use indicators combined by the government; on the side of patients’ ability to pay, for instance, income and family composition; on the side of treatments’ value, patients’ age and chronic comorbidities.
52 Dworkin, Sovereign Virtue, 73; Stanford Encyclopedia of Philosophy, Justice and bad luck, Chapter 7.
53 WHO, Noncommunicable Diseases. http://www.who.int/mediacentre/factsheets/fs355/en/.
54 OECD, Health at a Glance 2021, 94.
55 Pillutla et al., Rationing elective surgery; Pennestrì, Dalla cura al prendersi cura.
56 WHO, Health Technology Assessment. https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/medical-devices/assessment.
57 EuNetHTA, HTA Core Model Domains. https://www.eunethta.eu/hta-core-model/.
58 The King’s Fund, Getting the most out of Proms, 54–55; Bognar et al., op. cit., 63.
59 Fondazione Gimbe, III Rapporto sulla sostenibilità del SSN, table revised by the author.
60 Bognar et al., op.cit.; Daniels, op.cit.; Daniels et al., Accountability for reasonableness: an update; Friedman, Beyond accountability for reasonableness.
61 Rumbold et al., Public Reasoning and Health-Care Priority Setting; Kieslich et al., Does accountability for reasonableness work?; Byskov et al., The accountability for reasonableness approach.
62 Daniels, op. cit.