Flood Colleen, Gross Aeyal
Professor in the Faculty of Law, University of Ottawa, Canada.
Associate Professor in Tel Aviv University's Faculty of Law, Visiting Reader at SOAS, University of London.
Health Hum Rights. 2014 Dec 11;16(2):E62-72.
This article presents research demonstrating that the right to health plays different roles in different types of health systems. In high-income countries with tax-funded health systems, we usually encounter a lack of an enforceable right to heath. In contrast, rights play a more significant role in social health insurance/managed competition systems (which are present in a mixture of high-income and middle-income countries). There is concern, for example in Colombia, that a high volume of rights litigation can challenge the very sustainability of a public health care system and distort resources away from those most in need. Finally, in middle-income countries with big gaps between a poor public health system and a rich private one, we are more likely to find an express constitutional right to health care (or one is inferred from, for example, the right to life). In some of these countries, constitutional rights were included as part of the transition to democracy and an attempt to address huge inequities within society. Here the scale of health inequities suggests that courts need to be bolder in their interpretation of health care rights. We conclude that in adjudicating health rights, courts should scrutinize decision-making through the lens of health equity and equality to better achieve the inherent values of health human rights.
本文介绍的研究表明，健康权在不同类型的卫生系统中发挥着不同作用。在实行税收资助卫生系统的高收入国家，我们通常会遇到缺乏可执行的健康权的情况。相比之下，权利在社会医疗保险/管理竞争系统（存在于高收入和中等收入国家的混合体中）中发挥着更重要的作用。例如在哥伦比亚，人们担心大量的权利诉讼可能会挑战公共卫生保健系统的可持续性，并使资源从最需要的人群中转移出去。最后，在公共卫生系统薄弱与私人卫生系统发达差距巨大的中等收入国家，我们更有可能发现明确的宪法规定的医疗保健权（或者是从例如生命权中推断出来的权利）。在其中一些国家，宪法权利是作为向民主过渡的一部分以及解决社会巨大不平等现象的一种尝试而纳入的。这里卫生不平等的规模表明，法院在解释医疗保健权利时需要更加大胆。我们得出结论，在裁决健康权时，法院应通过健康公平和平等的视角审查决策，以更好地实现健康人权的内在价值。
