World Medical Association, Statement on Access to Health Care (1988)

Adopted by the 40th World Medical Assembly
Vienna, Austria, September 1988



PREAMBLE
Access to medical care is a multi-dimensional concept that involves a balancing of factors within the practical constraints of a specific country's resources and capabilities. The factors include manpower, financing, transportation, freedom of choice, public education, quality, and allocation of technology. The balance of those elements which maximizes the quantity and quality of care the populatiuon actually receives, determines the nature and extent of access to care.

GUIDELINES

Manpower
National Medical Associations should join with other concerned groups from both the private and public sectors to address issues related to the supply and distribution of health manpower. Data should be collected to assess supply and distribution and determine the appropriate mix of health professionals and health workers that can effectively meet the needs of the population. Special efforts should be made to attract physicians and allied health care providers to underserved geographic areas through a variety of incentives and programs. Looking ahead to long-term needs, incentives should also be created to attract medical school students who wish to work in regions where there are manpower shortages.

FINANCING
A pluralistic financing system should be developed that contains elements of both public and private funding. The system should be based on standards of uniform eligibility and benefits, and it should include adequate payment mechanisms for this purpose. These mechanisms should be clearly explained to the public so that all concerned understand the payment options available to them. Where appropriate, incentives should be provided for those in the private sector to provide care to patients who otherwise would not have access to it. No one who needs care should be denied it because of inability to pay. Society has an obligation to provide a reasonable subsidy for needed care, care of the needy, and physicians have an obligation to participate to a reasonable degree in such subsidized care. Governments have an obligation to administer such plans fairly and objectively.

TRANSPORTATION
Society has an obligation to provide transportation to medical facilities for patients who live in remote areas. Transportation should also be provided to rural patients who require a sophisticated level of care that can be found only in metropolitan medical centers. Physicians have an obligation to offer reasonable support to such plans.

FREEDOM OF CHOICE
All health care delivery systems should provide each individual with the greatest possible personal freedom of choice in selecting a provider or health care mechanisms, regardless of whether they are based in the private or public sector. To promote informed personal choice, adequate information concerning both private and public sector options should be made available to the public providers, employers and other payors of health care.

PUBLIC EDUCATION
Educational programs that assist people in making informed choice about their personal health and about the appropriate uses of both self-care and professional care should be established. These programs should include information about the costs and benefits associated with alternative courses of treatment; the use of professional services that permit early detection and treatment, or the prevention, of illnesses; personal responsibilities in preventing illnesses and the effective use of the health care system.

In local communities, it is important that the public understand health care plans designed for their benefit and how these plans affect everyone concerned. Physicians have an obligation to actively participate in such educational efforts.

QUALITY
Quality assurance mechanisms should be part of every system of health care delivery. Physicians, in particular, should accept a responsibility for being guardians for the quality of medical care and should not allow other elements of access consideration to jeopardize the quality of care provided.

ALLOCATION OF TECHNOLOGY
Guidelines should be developed for the allocation of scarce health care technologies in order to meet the needs of all patients.

CONCLUSIONS
Access appears to be maximized when the following conditions exist:
- Adequate medical care is available to every individual (i.e. no physical or time constraints).
- There is maximum freedom of choice of providers, delivery systems, and payment systems to accommodate the diverse needs of the population.
- Information, education and awareness by the public of every aspect relating to access to care.
- Adequate participation by all parties in systems design and administration.