Chatham House Paper: Continued medical detentions are ‘degrading and abusive’

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A new Chatham House paper suggests medical detentions – where hospitals forcibly detain patients unable to pay their medical bills – are common practice across much of sub-Saharan Africa, as well as parts of India and Indonesia.

Many reported detentions result from emergency care, often following road accidents or complications in childbirth, with mothers being separated from their newborns.

Hospital Detentions for Non-payment of Fees: A Denial of Rights and Dignity assesses the prevalence of medical detentions globally, the health and human rights impacts, and policy options to reduce and eradicate the practice.

Co-author Robert Yates, Project Director of the Universal Health Coverage (UHC) Policy Forum at Chatham House’s Centre on Global Health Security, said: ‘There is no justification – at any income level or in any country – for health facilities to detain people and, in effect, take them hostage until someone can cover their bill.

‘The practice is psychologically and economically crippling – and also disastrous for health outcomes. Fears of debt and detention are scaring people out of seeking life-saving and preventative treatments. 

He added:  ‘There is a clear and practical solution to this problem: eliminate healthcare user fees and provide universal free healthcare.’

The paper suggests that:

·         Medical detentions remain prevalent across much of sub-Saharan Africa, and also take place in India and Indonesia. From available evidence, the paper estimates the annual global figure of medical detainees could be in the hundreds of thousands. It finds that there is likely to be significant underreporting, and that the geographical scope is likely to be wider than demonstrated by available research. 

·         Many reported detentions are the result of emergency care, which a patient has no choice but to receive and often costs more than they can afford. These cases often involve the victims of road accidents and women suffering complications in childbirth.

·         The practice is a denial of international human rights standards, including the right not to be imprisoned as a debtor, and the right to access to medical care. People are forcibly detained for months, often in degrading and highly abusive conditions. There are reports of women being pressured into having sex with hospital staff to pay off their medical bills, and of mothers being separated from their newborns.

·         Fear of debt and detention also make women less likely to seek out other types of medical services, such as family planning and antiretroviral treatment, and has been cited as a reason for cancer patients abandoning treatment.

·         As well as being psychologically distressing, medical detentions can be economically disastrous for victims, preventing those who are well enough to leave hospital from returning to work and maintaining their livelihoods, and so deepening pre-existing poverty.

·         The detentions are often used for political gain, with leaders paying off bills to gain publicity, even in countries where the practice has been banned. Hospitals have in certain instances actively encouraged the publicising of cases, viewing it as a way of increasing the likelihood of costs being paid.

It also notes that:

The main underlying cause of the problem relates to shortcomings in health financing systems. Governments must state unequivocally that detention is illegal – but legal solutions are unlikely to succeed without governments providing the necessary finance to hospitals to cover their costs.

It may also be necessary to invest in improved governance and enforcement mechanisms. However, the simplest way to tackle the issue is not through legal and governance reforms, but through reforming health financing systems so that people are not presented with unaffordable medical bills.

Universal Health Coverage (UHC) – a target within the UN Sustainable Development Goals – is achieved when everyone in society receives the health services they need without suffering financial hardship. The problem of medical detentions can be effectively eliminated when countries adopt the right policies to achieve UHC – specifically by moving towards pre-paid public financing mechanisms that pool contributions from across society.

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