Challenges to the Right to

Health Care. A Comparative

Perspective.

André den Exter

Outline

• Background

• Meaning of the Right to Health Care in International Law: Recent Developments

• The Right to Health Care in National law

• The Justiciability of Health Care Access: Case studies

• Future Challenges

• Relevance to the Ukraine?

Background

Economic crisis & Increase health care costs

Health care market reforms

Rationale

Health care access as a recognised human right

Litigating healthcare access

Rationing

Role of the Legislature

Meaning of the Right to Health Care in International Law: Recent Developments

Art. 12 (1) ICESCR ‘highest attainable standard of physical and mental health’

Art 12(2) ‘Steps to be taken to achieve the full realisation of this right, in particular ....’

General Comment on Health No. 14:- Minimum core obligations - Typology of obligations- AAAQ- Progressive realisation & no retrogressive measures

Monitoring health care access and ‘human rights indicators’

The Right to Health Care in National law: Global Trends

Constitutional / Statutory Right

Explicit or implicit recognition

Constitutional commitments:

- equitable distribution and non-discriminatory access

- treaty obligations outlined in international law

- irrespective the health care model

Monitoring and review system (accountability)

The Justiciability of Health Care Access: Case studies at the European Human Rights CourtMedical asylum seekers

D. v. UK, App. no. 30240/96 (St Kitts): Deportation AIDS infected patient subject to inhuman treatment?

Prisoners

G. v. France, App no. 27244/09: Lack specialized treatment/ psychiatric supervision and inappropriate conditions detention: Inhuman degrading treatment

Non-listed treatment methods

Panaitescu v Romania, App no 30909/06 (ECtHR, 10 April 2012): denial of life saving medicine; breach right to life

Hristozov v. Bulgaria, App no 47039/11 and 358/12 (ECtHR, 13 November 2012: no obligation to regulate access to unauthorised medicines

The Justiciability of Health Care Access: Rationingby national courts

UK: Swindon NHS Primary care Trust (Herceptin litigation)

Netherlands: Cost sharing under Health Insurance Act annuled under ILO Convention 102/ECSS provisions (29-5-1996, 8-9-2006)

Poland and Czech R.: Introduction HIS and Co-payments: (restricting benefits); (K 8/96, 275 and K7/95, 414; Pl. US 1/08, 23 September 2008)

Austria: Viagra and Human Rights; OGH (10 ObS 12/06x):

The Justiciability of Health Care Access (2): Tragiccases

New medical technologies and limited cost-effectiveness

Germany: BVG 6 Dec 2005 (Nikolaus Beschluss): lifesaving (experimental) medicine

‘Constitutional rights & likely positive effect on the course of the disease’

Switzerland: Fed. Supreme Crt. (Myozyme case), 23 Nov 2010

‘Cost-effectiveness threshold 100.000 CHF QALY’

Policy Implications: Transparent criteria & RationingProcedure

Future Challenges

Rationing and Role Judiciary

Innovative approach: Expanding definition human rights & measuring States’ progressive realisation

Court’s referral to and applying Oviedo Convention, art. 3

Role of the EU Court Justice and EU Human Rights Charter

Democratic debate on Rationing decision-making and moraldilemmas

Importance of professional guidelines/protocols, adressingboth clinical and cost-effectiveness & human rights arguments

Fair rationing

Relevance to Ukraine?

References

A. den Exter, Health care Law-making in CEE. Review of a Legal-

Theoretical Model, Maklu Press (2002)

A. den Exter and M. Buijsen (eds.), Rationing Health Care. Hard choices

and unavoidable trade-offs, Maklu Press (2010)

A. den Exter (ed). Compendium of European Health Law, Maklu Press

(2016)

/www.bmg.eur.nl/english/research/eu_projects/jean_monnet_programme

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Contact: denexter@bmg.eur.nl