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Respuestas adaptativas, derecho a la salud y el límite del criterio de satisfacción: una reflexión y puesta en evidencia desde el sistema de salud peruano
(Pontificia Universidad Católica del Perú, 2024-05-29)
Some utilitarian readings present in bioethics emphasize the importance of satisfying people’s preferences as a significant criterion of justice. One of its recurring applications in the healthcare sector is through measuring the satisfaction of healthcare service users. However, little has been discussed in the healthcare and bioethics field regarding objections that this criterion has faced from the philosophy of law and political philosophy. One of these, known as the problem of adaptive responses, asserts that individuals, whether consciously or not, adjust their satisfaction based on what they can attain. Therefore, a cautious view of this criterion is recommended, especially when measuring the satisfaction of individuals facing deprivations. Greater caution should be exercised when it is applied to services that guarantee fundamental rights, such as the right to health. This article aims to discuss this issue and highlight its presence in the healthcare services of Peru. Specifically, after tentatively and briefly conceptualizing what an inappropriately adaptive response would be, this problem will be analyzed and evaluated based on certain components of the National Survey of User Satisfaction of Universal Health Assurance (Ensusalud) of 2014, 2015 and 2016, which are the only three surveys of this kind conducted in Peru to date and on a national scale. In more detail, the aim is to determine whether significant differences in satisfaction with their health insurance exist among users based on their income levels, considering the same degree of impact on their right to health. The processing and analysis of the database lead to the conclusion that these differences do indeed exist. Faced with a infringement on this right (for example, not receiving any medication at the pharmacy, taking more than ninety minutes to reach the facility, etc.), severe economically deprived users express higher levels of satisfaction with their insurance compared to users without economic deprivations. This provides indications to suspect that, in relation to the first group of users, there might indeed be a case of adaptive responses.
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A ‘common sense’ response to health inequalities in Peru? Public-private partnerships in health and the implications for the right to health and economic inequality
(Oxford University Press, 2024-11-01)
Drawing on the case of Peru, our analysis looks at the ways in which the mainstream media creates support for government policies aimed at implementing Public-Private Partnerships (PPPs) in the health sector. Peru has a highly fragmented and segmented healthcare system, and the COVID-19 pandemic exposed the deeply embedded inequalities in accessing healthcare across the country. Nevertheless, the construction of hospitals financed and managed via a PPP arrangement has been one of the major solutions proposed and implemented by successive Peruvian governments in response to the health sector’s challenges. As our analysis demonstrates, the media has played a significant role in promoting this ‘common sense’ agenda whereby greater reliance on the private sector is presented as a solution to the weaknesses of the public sector. Our article considers the wider evidence on the role of PPPs in the health sector and contends that there is very little evidence on the system-wide benefits of PPPs, thus raising significant concerns about their ability to address health inequalities effectively. It also raises important questions about how far PPPs are able to support states in guaranteeing the right to health for their citizens.
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