SoAH-Oct2006
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Handbook of WMA Policies
World Medical Association ⏐ S-1988-02-2006
WMA STATEMENT
ON
ACCESS TO HEALTH CARE
Adopted by the 40th
World Medical Assembly, Vienna, Austria, September 1988
and revised by the 57th
WMA General Assembly, Pilanesberg, South Africa, October 2006
PREAMBLE
1. The Constitution of the World Health Organization states that the “enjoyment of the
highest attainable standard of health is one of the fundamental rights of every human
being….” Access to health care is a multi-dimensional concept that involves a bal-
ancing of factors within the practical constraints of a specific country’s resources and
capabilities. The factors include health human resources, financing, transportation,
freedom of choice, public education, quality, and allocation of technology.
GUIDELINES
Health Human Resources
1. 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 human resources. 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. Punitive or coercive models should not be em-
ployed. 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 health human
resource shortages.
Financing
2. A pluralistic financing system should be developed that contains elements of both
public and private funding. The exact mix of financing may vary significantly from
country to country. 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 under-
stand 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 care of
the needy, and physicians have an obligation to participate to a reasonable degree in
such subsidized care. Governments have an obligation to ensure that such plans are
administered fairly and objectively.
S-1988-02-2006⏐ Pilanesberg
Access to Health care
Transportation
3. Society has an obligation to provide adequate access to medical facilities for patients
who live in remote areas. Transportation should also be provided to isolated rural
patients who require a sophisticated level of care that can be found only in metropoli-
tan medical centres. Telemedicine can sometimes be an acceptable substitute for trans-
portation of patients.
Freedom of Choice
4. All health care delivery systems should provide each individual with the greatest
possible personal freedom of choice in selecting a physician. To promote informed
personal choice, adequate information concerning both private and public sector
options should be made available to the public, employers and other payers of health
care.
Public Education
5. Educational programs that assist people in making informed choices about their per-
sonal 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 ser-
vices that permit early detection and treatment or prevention of illnesses; personal
responsibilities in preventing illnesses; and the effective use of the health care system.
Patients should be given access to, and retain, copies of their own medical records.
6. In local communities, it is important that the public understand health care plans de-
signed for their benefit and how these plans affect everyone concerned. Physicians
have an obligation to actively participate in such educational efforts.
Quality
7. 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 considerations to jeopardize the
quality of care provided.
Allocation of Technology
8. Guidelines should be developed for the allocation of scarce health care technologies
in order to meet the needs of all patients and heath care practitioners and to ensure the
fair and equitable allocation of technology and resources across the health care sector.
CONCLUSION
Access is maximized when the following conditions exist:
1. Adequate medical care is available to every individual, regardless of ability to pay.
2. There is maximum freedom of choice of health care providers and payment sys-tems
to accommodate the diverse needs of the population.
Handbook of WMA Policies
World Medical Association ⏐ S-1988-02-2006
3. The entire population has easy access to adequate and comprehensive information on
health care providers.
4. There is adequate opportunity for active participation by all parties in healthcare
systems design and administration.
5. Physicians are provided with transparent and efficient ethical criteria for working in
overcrowded health systems that endanger health care.
6. Medical associations promote equal access to health care, both locally and na-
tionally, through dialogue and common activities with health authorities.