Prevention in healthcare

Résumé du document

Most developed countries have implemented healthcare systems. As reminded by Bruno Palier in The Healthcare Policy Quadrilemna, these policies were led with common objectives: "to help the sick on low incomes, then to guarantee a substitute income for salaried workers suffering from illness and, for Europeans after World War II, to ensure access to healthcare for all". They were a way to reduce the inequalities which threatened the unity of society, which is to say to increase the liberty of those whose choices were restrained by illness. Prevention has always existed, in all societies. But we can consider that its development really started at the end of the 18th century. It is constituted of cures, one of the two dimensions of health. Whereas cure occurs when a person is already sick, prevention occurs before. Today, prevention is an important stake for all countries where health expenditure is increasing while the increase of taxes or social contributions is not conceivable in a context of globalization.

Extraits

[...] This is approximately what the American Neoconservatives believe. So this observation should prompt us not to make confusion. a. The liberal purpose As we said, prevention can also be a way to increase workers productivity. This trend is also important. According to Michel Foucault, modern states regulate their population through "an explosion of numerous and diverse techniques for achieving the subjugations of bodies and the control of populations." In our modern societies, the risk has almost entirely disappeared; we cannot accept it anymore. [...]

[...] So prevention, as traditional healthcare, is mainly a way to turn "formal liberty" into "real liberty". But at the same time, as we showed above, prevention can be led through coercive measures. Therefore we can wonder whether there is a paradox or not, and if prevention really increase liberty. a. The moral purpose Many measures which look like prevention measures actually have moral purpose. This ambiguity can be illustrated by the example of alcohol. Today alcohol consumption is restricted in most countries, but for different and complementary reasons. [...]

[...] This trend may be due to the consistence of prevention policy: it is developed in the first group, it is not in the second one. But there are some exceptions: in France and in Norway, tobacco is expensive and little money is devoted to prevention; in Sweden, this is the contrary, tobacco is cheap and much money is devoted to prevention. In Sweden, this is certainly explainable by the fact that only of the population smoke daily, which is the lowest rate in Europe (maybe for a specific cultural reason); we can consider that Sweden would have increased the price of tobacco if it had been necessary. [...]

[...] So in such system, prevention activities must be at least as remunerated as curative activities. Another solution can be the creation of specialized structures devoted to prevention of which mode of remuneration be different. On the other hand in national health systems, practitioners are paid even if their patients are not sick. So on the long-term, it is in practitioners' interest to make prevention, even ill-remunerated, because prevention will release time which will be reinvested in new patients. Some countries as the United Kingdom have been further by establishing financial incentives for providers. [...]

[...] III - Is prevention really justified? Of course, preventing people from being sick, prevention increase people's liberty. Because when you are sick, your room for manoeuvre dramatically decrease; you cannot make the choices you would like to make; most of the time you cannot have the job you would like to have, and in countries where healthcare is not free or very cheap, you have to use your money to be cured, so you cannot use it for other purposes. [...]