Global health. A concept. A field of medicine. A sector of international relations. A key part of human rights. What people think of when they hear ‘medical outreach trips’ or ‘mission trips’. But what exactly is the main overarching goal of global health?
To increase access to healthcare around the world, and to work together to strengthen delivery on a global scale. (more on this here!)
Setting up short term clinics in developing countries absolutely has a time and place. For example, when natural disasters strike or when wars completely destroy the healthcare systems in place. But what if we can do better than just providing temporary care, leaving patients lost to follow up? This is where communication, cooperation and teamwork come in. We need to work together to strengthen healthcare systems and find sustainable solutions to problems. But first, we need to learn. And this can start at any level of your career: travel, learn, observe, study, be inquisitive, and absorb.
Students in Global Health
As a student, you can start your career in global health by going on these ‘medical outreach trips.’ At this stage in our careers, I don’t love the term ‘medical outreach’ or ‘medical mission trip.’ As students, we are learning. So the point is not to ‘provide healthcare’ or to do procedures that you would otherwise be unauthorized to do in your own country. The point is to learn about healthcare delivery in that location and start to build a foundation of knowledge and experience that will one day help you be a part of solving the worlds problems. You can absolutely lend a helpful hand, but always be respectful and know your limitations. I recently had the amazing opportunity to go with CFHI to Argentina to learn about hospital medicine. I have a whole blog post about this AMAZING organization coming out soon! But for now, let’s talk about healthcare in Argentina and how learning about this system and others impacts global health.
Becoming a Doctor in Argentina
First, let’s start out with what it takes to become a doctor in Argentina compared to in the United States. In Argentina, medical school is 6 years long and you start right after high school. In the United States, you need to get an undergraduate degree, and then you apply and get into medical school, which is 4 years. All public schools are free in Argentina (private ones cost money but it is nothing compared to the quarter of a million dollars that students in the US pay to become a doctor). After medical school, both US and Argentine doctors must do a residency in the specialty they are going to do. This is 3-7 years (plus fellowship), depending on your specialty.
Compensation is drastically different (but then again, so is the cost of schooling and the hours spent at the hospital). In the public hospitals (we’ll get to the private ones in a minute), doctors make the equivalent to $12,000 US dollars a year. In the US, a hospitalist will make around $275,000/year (this number changes depending on many factors). However, the hours are a lot harsher in the US. There is a shortage of doctors in the US while there is a plethora in Argentina.
Healthcare in the Society
But now let’s shift perspectives and talk about healthcare from the viewpoint of the public and the patients. Public hospitals are 100% free of charge to all. Citizens, visitors, neighboring countries, anyone. In Argentina, healthcare is a right, not a commodity. However, the public hospitals are very resource-poor. Sometimes people cannot get the tests, surgeries or procedures that they need. If you can pay out of pocket or get health insurance, citizens can go to private hospitals. These are better equipped to handle more complex or high risk cases. They also are more convenient for people because they are less crowded.
Is Healthcare a Right?
So can we really say that healthcare is solely a right and not at all a commodity? People are willing to pay more for technologically advanced healthcare. This leaves the patient population in the public hospitals primarily people living well below the poverty line. Fortunately, these people are able to get healthcare when they otherwise would not be able to afford it. However, does healthcare inevitably become a commodity because people will pay for more advanced private healthcare?
So why are people paying more for something that they can obtain for free? Are the doctors better in the private healthcare system? Not necessarily. In fact, you could argue that the doctors in the public healthcare system are ‘better’ because they are forced to diagnose and treat with limited resources. This leads to more developed clinical reasoning and cost effective healthcare. In reality, many doctors work in both the private and public healthcare system.
So, awesome. More advanced clinical reasoning means healthcare that is cost effective. But, humans are humans. Diseases are never textbook-perfect. And sometimes you just need those more expensive tests. The private hospitals can order more tests, do more imaging, and catch diseases at earlier stages, improving your prognosis.
How Does this Compare to the US?
The United States is still figuring out which direction they are going with healthcare delivery. Right now, people who cannot afford insurance might qualify for medicare or medicaid. All hospitals will accept anyone, regardless of insurance or ability to pay. However, the patients will get an enormous bill at the end of their stay leaving them even further in debt than they were before.
This is a huge debate in the US right now. Should we have universal healthcare that is run by the government? Should we solely have private insurance companies turning healthcare into a business and utilizing supply and demand? Is it actually more efficient and more cost effective if we utilize a little bit of both? Is healthcare a right or a commodity?
The Big Picture
So where does all of this fit into the global picture of healthcare? In an ideal world, healthcare would be provided to everyone. Even more ideally, said healthcare would be advanced modern medicine. Argentina has a healthcare system that provides solid medical care to all (but with limited resources). They also have more advanced private healthcare available to those that can afford it.
So if healthcare is a right, will it also inevitability become a commodity? At the end of the day, if healthcare is available to all, it must be funded (and how is the big political debate). But what cannot be debated is the fact that it is an essential (and very costly) part of the world. Societies cannot grow if people aren’t healthy enough to work or enjoy life. So what is the solution? How can we fund and provide healthcare to all? I don’t know. But I do know that continuing to study, learn and experience healthcare systems throughout the world will help us develop better systems globally. And excellent communication with leaders that have open-minded view points and innovative minds is the key to making this happen.