Does Constitutional Right to Health Matter?

Presenter: Hiroaki Matsuura, Harvard University

Abstract

Rationale: Constitution defines the rights of citizens as well as governing structure of the country. In many constitutions, health is stated as one of the fundamental rights of citizens or the goals of nation. However, it is not clear what the constitutional description of “health” means to the country’s actual health system. This paper attempts to provide the answer to this unknown question, and seeks the relationship between statement of “health” in constitution and actual health system.

Objective: The objective of this paper is to evaluate the effect of description of “health” in constitution on health expenditure, coverage, and outcome.

Methodology: We used 171 country level panel data from World Development Indicators (WDI) and National Health Accounts (NHA). Using Kinney and Clark (2004)’s classification, we first classified constitutional description of "health” into three categories (no statement, statement of aspiration, and statement of entitlement). Then we conducted multivariate analysis (OLS and IV) to estimate the effect of constitutional description of health on (1) per capita government health expenditure, (2) the share of health expenditure in total government expenditure, (3) measles and (4) DPT immunization coverage, (5) life expectancy, (6) infant mortality, and (7) under-five mortality.

Result: We found that explicit statement of entitlement in constitution does not effect on per capita government health expenditure and the allocation of government spending on health, but significantly improves measles and DPT immunization coverage as well as life expectancy, infant mortality, and under five mortality.

Conclusion: The result suggests that while constitutional description of “right to health” does not increase country’s financial commitment to health on average, it improves poor people’s access to basic health service and, therefore, health outcome. This finding is interpreted that “right to health” in constitution is translated to the achievement of minimum standards of health for the bottom by changing the allocation of health resource in one country rather than increasing total government’s financial commitment in reality.