Here we are at the start of another new year and, hitting the headlines this week, we have a debate about whether or not to charge people for accessing Accident and Emergency Services. In several places in Part III of Contemporary Health Studies we discuss the importance of access to health services for promoting and maintaining health. By way of illustration, there is a clear relationship between the proximity of maternal health services and outcomes for mothers and newborns (UNICEF, 2010). The disparities between more well-off countries and less well–off are huge when we look at crude indicators of health such as infant mortality rates. Infant Mortality Rates (IMR) measure the number of deaths up to the first year of life per thousand live births. IMR is used as a measure of the health status of a country and of development progress. As such it is intrinsically linked to the Millennium Development Goals for 2015. Here in Leeds the IMR varies across the city in a pattern linked to relative disadvantage and deprivation – in 2011 the IMR was 5.6 deaths per 1000 live births across the whole city but 8.2 deaths per 1000 births for the most deprived areas of Leeds (YHPHO, 2012). The same pattern can be seen on a global scale – in 2005 in Japan the IMR was fewer than 10 whilst in Afghanistan the IMR was over 150 (CEISIN, 2005).
Whilst many factors will contribute to such gross inequality, access to healthcare services makes a huge difference to health outcomes (WHO, 2013). For those who support a fee-charge to attend A&E or access emergency care the arguments lie in reducing the number of ”unnecessary” attendances focusing resources and expertise at greatest need. The contention is that “time-wasters” will think twice about presenting to A&E if they are charged for doing so. In the UK an estimated 27% of all A&E attendances are linked to alcohol (Patton, 2012) and there have previously been calls for people to be charged if needing attention due to being under the influence of drink. However, those who are against charging people to access emergency services recognise that such measures often impact more negatively on those most in need, by penalising poorer patients, therefore widening inequalities in health.
This, of course, leads us onto a much larger debate about whether healthcare should be free at all or whether people should pay for it which also links to a much wider, inescapably political issue about responsibility for health. The key question is therefore this – is health the responsibility of the individual or is it the responsibility of the state? In Contemporary Health Studies we discuss these issues in greater depth throughout the book.
It remains to be seen what will come of the debate about charging for emergency care in the UK but critics are already concerned that we are moving towards a more American-ised system of healthcare where only those who can afford it (or have insurance) have access to the best standards of care. The problems with privatising healthcare are clear. As Wilkinson and Pickett (2009) nicely demonstrate, the USA boasts inequitable differences between the best-off and the least well-off which impact at all levels of society and in a number of different ways from levels of crime to experiences of mental health.
We would be interested to hear what you think about these issues.