Adopted by the 40th World Medical
Assembly,
Vienna, Austria, September 1988
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 population
actually receives, determines the nature and extent of
access to care.
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 undeserved 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.
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.
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 centres. Physicians
have an obligation to offer reasonable support to such
plans.
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 payers of health care.
Educational programs that assist people in making informed
choices 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
with 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 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.
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