Political programs and strong resonating promises of politicians in Egypt repeatedly talk about “Free healthcare as a right”. Aside from the poetic impracticality of such promises in a country where three quarters of the total healthcare expenditures are out-of-pocket household expenditures, the question we ask is: “Is Free healthcare” a notion worthy of dreaming of in the first place?
For many, free medical care embodies a “right to medical care”, irrespective of whether cost sharing affects health status or not. Such individuals should ask themselves what is really being bought by medical care that is free at time of treatment. Clearly free care is costly because of the additional use it stimulates. What benefits are bought for these extra costs?
J. P. Newhouse and the Insurance Experiment Group, Free for all?”, Lessons from the RAND health insurance experiment, A RAND study, Harvard University Press, 1993, P. 356
The RAND Health Insurance Experiment is the largest and longest running social science research project ever completed. Approximately 2000 non-elderly families from 6 different regions in the U.S. were assigned to insurance plans that varied the price of services and the “packaging”.
The study’s results clearly show that the “Free care” option ended up not offering added benefits to the average person. In addition, the study argues that the increased inappropriate care in case of “Free care” was not just zero-benefit care; it actually had negative effects. Examples of such care include prescribing antibiotics for viral infections, thus incurring side effects in some fraction of cases for no gain; inappropriate hospitalization; and labeling effects.
Other studies tend to align with this argument in stating that one sixth to one third of certain medical procedures do not produce a benefit sufficient to justify the clinical risk and that close to 4 percent of hospital admissions result in iatrogenic treatment or induced injury that prolongs the stay or causes a disability that lasts past the stay.
It is therefore a necessity to reconsider with a critical eye the value of “free medical care” for what it truly delivers. One needs to consider two arguments in this perspective: 1) The issue is the efficacy of the additional medical services induced by free care, not the efficacy of any medical service and 2) Although medical services are beneficial in many instances, in some instances they are not. Just as a right to food does not preclude overeating, a right to medical care does not preclude over treatment
Sources:
J. P. Newhouse and the Insurance Experiment Group, Free for all?”, Lessons from the RAND health insurance experiment, A RAND study, Harvard University Press, 1993, P. 357
Chassin, Mark, et al., Does inappropriate use explain geographic variations in the use of Health Care Services? A study of three Procedures, Journal of the American medical association 258, 1987, P. 2533-37
Brennan, Troyen A., et al., Incidence of adverse events and negligence in hospitalized patients: Findings from the harvard medical practice study, New England journal of medicine 324, 1991, P. 370-376
J. P. Newhouse and the Insurance Experiment Group, Free for all?”, Lessons from the RAND health insurance experiment, A RAND study, Harvard University Press, 1993, P. 358