OECD Observer
Don’t forget, employees make healthcare work

Healthcare must be maintained as an essential public good

Workers and their families consider good, equitable and affordable healthcare as a top priority. Trade unions support strategies that aim to achieve this; they are committed to the provision of comprehensive, high-quality and affordable healthcare. But when misguided reforms push health costs onto the budgets of working families, trade unions will oppose such moves.

We agree that particular attention needs to be given to the improvement of the quality of care and patient safety.

The design and implementation of effective health policy requires much more than better data on quality. It requires a comprehensive approach, including the provision of decent working conditions for the health workforce as well as appropriate and continuous vocational training. Moreover, it also requires appropriate participation of all stakeholders. Health policymakers must take into account that one of the greatest assets of the health sector is its workforce. Improved quality of care can be achieved neither by the implementation of advanced IT- based patient records and co-ordination of care nor by patient empowerment and strengthened self-management alone. Rather, a well-trained, highly motivated workforce is essential for a health system to function smoothly.

The purpose of health systems is to protect and improve health. Besides treating people when they are sick, health systems must place greater emphasis on preventing disease and promoting healthier lifestyles. Spending on health promotion activities needs to be increased; its current level does not seem to be appropriate. Policy approaches to improve health must take into account the socio-economic context of life and work. That applies in particular to the adverse employment effects of the financial and economic crisis.

Nor must governments forget that unemployment is a major health hazard. There is compelling evidence suggesting that unemployment is strongly associated with mortality and morbidity, harmful lifestyles and a decreasing quality of life. Clearly, tackling unemployment and creating a job-rich recovery would be a budget saver for healthcare, both in the short and medium term.

A universally accessible public health system is a fundamental right. Healthcare must be maintained as an essential public good. An accessible, fair national health system is incompatible with the idea of a fully private, “for-profit” delivery of health services. Most serious observers of the health service sector believe that for-profit delivery of health services does not reduce health costs, nor relieve pressure on the public system or improve the quality of care.

There is no one-size-fits-all way to make health systems more efficient, nor is it desirable to propose a universally applicable “blueprint” for a system of healthcare provision. OECD countries need to share information on what works in practice. That requires more than the collection and dissemination of comparable data and indicators on the quality of care. It requires in particular a qualitative analysis on what works and what doesn’t.

TUAC would urge a stronger focus on work-related as well as on environmental and social determinants of health in order to develop and implement effective strategies of prevention.

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©OECD Observer No 281, October 2010