Inequalities in Health Care Provision

By Cowling, Dan | Teaching Geography, Summer 2014 | Go to article overview

Inequalities in Health Care Provision


Cowling, Dan, Teaching Geography


Health geography has come a long way since it first started creeping into geography A level specifications in the 1990s. In some schools it has become part of the key stage 3 curriculum, while it is a popular option in the AQA A level and also appears in the Edexcel A level course. Comparisons in health care provision can seem marginal to a geographical study of health disparities, especially when compared with studies of the spread of disease. However, such a study offers opportunities for students to investigate some of the differences between the development levels of different countries and to be aware of both the political and moral dimensions of health care provision. Further, as part of the new key stage 3 programmes of study, such studies can help students:

* extend their locational knowledge and the human characteristics of the world's countries

* investigate population issues and international development aspects of human geography.

Studying health care systems is a good way to introduce students to the topic of inequality. A comparison of health care systems reveals inequalities in provision, and these often have a geographical dimension - either in relation to population (e.g. the number of people per doctor, or the distribution of hospitals), or in terms of access to facilities (travel times to hospital, transport availability, or the cost of services).

Health care around the world

The World Health Report defines a health care system as 'all the activities whose primary purpose is to promote, restore or maintain health' (World Health Organisation, 2000). Health care systems encompass traditional healers and the home care of sick people as well as formal health services, and they have evolved from often smallscale private or charitable care into extremely complex organisations. In the past all health care was paid for by the user, but today it is funded in many different ways including general taxation, employer and employee contributions, health/ social insurance (both state and private), charities, NGOs (Non-governmental organisation), or a combination of these.

Globally, many governments have established planned health care systems. These vary widely between countries or even between different regions within a country. The way a national or regional health care system is organised is determined by a number of factors: social factors; political factors; the physical infrastructure of health facilities; and the needs of individuals. Of these, political factors are often dominant, so health care provision can reflect national political ideology.

The five aims in Figure 1 constitute a benchmark for the equal provision of health care.

State provision of health care

In many countries, to try and ensure some form of fair distribution of health care across the population, the state has an important role in health care provision. Even in the USA, whose health care arrangements most closely approach a 'free market' philosophy, the state plays an important part in health care provision. There are five main ways of collecting the revenue to finance health care systems:

* taxation

* social health insurance

* voluntary or private health insurance

* out-of-pocket payments (where payment is made at the point of accessing health services)

* donor contributions.

In 2006, estimated global expenditure on health care was around US$4.7 trillion, or 8.7 % of global income. This compares to 3 % in 1948.

The highest expenditure on health care in relation to income was in the Americas, at 12.8 %, and the lowest in Southeast Asia, at 3.4 %. Globally, this equates to spending an average of about US$716 per capita, but there is tremendous variation, from a very low US$31 per capita in Southeast Asia to a high of US$2636 per capita in the Americas (World Health Organization, 2006).

International inequalities

Comparing international inequalities in health care provision is an excellent tool for exploring geographical inequalities as it can open up some interesting discussions with students:

* Why isn't health care free in all countries? …

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