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Equity Healthcare in universal

health coverage era


Rais Reskiawan

Of all the forms of inequality, injustice in health care is the


most shocking and inhumane
Martin Luther King Jr

Introduction
According to the Indonesia Constitution, health
is the fundamental right of all people and
government compulsory to provide the best of
healthcare to all people.

Why equity in health care?


The social conscience is more offended by
severe inequality in nutrition and basic shelter,
or in access to medical care, than by the
inequality in automobiles, books, furniture or
boats

Tobin 1970

Equity
Equity is a fairness in thing and service
distribution. (Friedman)

Equity in health is everyone has a similar


oppurtunity to get good health care.

The principles of justice


Horizontal justice

Vertical justice

Fair act for similar


condition

Different act for


different condition

Horizontal Justice
Similar Resources/expenditure for similar need
Similar acceptance/using for similar need
Similar access for similar need
Similar of health level

Vertical Justice
Different act for different need
Based on ability to pay

Justice in healthcare fund


Justice in access
infrastructure
Justice in access
resources

of healthcare
of health human

Justice in other factor which effect.

Justice in healthcare fund


Absorption of fund

PBI
Non PBI

PBI : people who got subsidy

Health financing is not only about how much


money is expended by the health sector but also
about how efficiently and equitably resources are
raised, pooled, and allocated to achieve desired
health system objectives such as UHC.

Justice in access of healthcare infrastructure

Justice in access of health


human resources

Justice in other factor which effect

Health Status: Major Determinants


Toxins
Safety
Neighborhood
Racism
Discrimination
Occupation

Healthcare

Environment
Social
Physical

Providers
Institutions
Systems
Policies
Biology
Genetics

Health

Lifestyle
Choices
Beliefs

Education

SES
Income
Wealth

H. Jack Geiger. Health Disparities: What do we know? What do we need to know? What
should we do?. In Gender, Race, & Health: Intersectional Approaches. Edit by Amy J.
Schulz & Leith Mullings. San Francisco. Jossey-Bass, 2006.

Influence on Excess Mortality:


Poor & Minorities
Lifestyle

30%

Healthcare

10%

All others

60%

H. Jack Geiger. Health Disparities: What do we know? What do we need to know? What
should we do?. In Gender, Race, & Health: Intersectional Approaches. Edit by Amy J.
Schulz & Leith Mullings. San Francisco. Jossey-Bass, 2006, p. 265.

Universal coverage (UC), or universal health coverage


(UHC), is defined as ensuring that all people can use the
promotive, preventive, curative, rehabilitative
and palliative health services they need, of sufficient
quality to be effective, while also ensuring that the use
of these services does not expose the user to financial
hardship.

This definition of UC embodies three related objectives:


equity in access to health services - those who need the
services should get them, not only those who can pay for
them;
quality of health services is good enough to improve
the health of those receiving services; and
financial-risk protection - ensuring that the cost of
using care does not put people at risk of financial hardship.

The resistor of equity


Politics
Corruption
Protecion for other factors which effect

It is my aspiration that health


will finally be seen not as a
blessing to be wished for, but as a
human right to be fought for.
Former United Nations Secretary General, Kofi
Annan

It is my aspiration that health


will finally be seen not as a
blessing to be wished for, but as a
human right to be fought for.
United Nations Secretary General, Kofi Annan

Koefisien Gini meningkat dari 0.37


(2012) ke 0.41 (2013)

Health
Inequalities
Race Ethnicity Socioeconomic Status Gender - Sexual Orientation - Other

Social
Determinants

Healthcare

Definisi UHC
Universal health coverage (UHC) means that all
people receive the health services they need
without suffering financial hardship when paying
for them. The full spectrum of essential, quality
health services should be covered including
health promotion, prevention and treatment,
rehabilitation and palliative care.

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