AFRO-NETS> Health Cards (9)

Health Cards (9)
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I would also like to voice some concerns about the health card. In many
countries where I have worked, the state is not particularly benevolent,
and health care providers exercise considerable power vis-a-vis poor
clients. I fear that the card could be misused if it is too comprehensive.
For example, people who did not show their card could be "rightfully"
denied treatment by providers. This could even spawn a new class of
exploiters: providers willing, for a price, to treat people who are
reluctant to show their cards to others.

Unfortunately, in places where many people are illiterate, I question if
the card would be a form of "empowerment" for them, or is really in their
best interests. It could make it harder for them to obtain second
opinions, because providers would insist on first examining the person's
card. While this could discourage self-referral, which could increase
efficiency, it also could trap people at the lower levels of the health
care delivery system, where they face sometimes poorly trained and
unscrupulous providers, who are badly equipped.

Another problem with the cards is that they would only be records of legal,
Western medical treatment. In a country like France, this would not be a
major drawback. But in many parts of the world, this would be a very
inaccurate record of the care people have received. In fact, it might even
increase people's recourse to traditional healers or "private"
practitioners, for reasons mentioned above.

Finally, many providers already spend very little time in consultation with
clients. I am afraid that having yet another card to fill out, or to update
(with client's address, etc.) will reduce this consultation time even
further, and encourage more "interrogation" rather than counselling.

Certainly, cards can be useful records of some health interventions
(particularly immunisations and prenatal visits), as well as for people
with chronic health conditions (such as diabetes) who travel frequently.
But too much more than that may have unexpected consequences.

So I join others in expressing caution about the introduction of health
cards for the mass public.

Sincerely,

Paula Tavrow
Doctoral candidate
School of Public Health
University of Michigan
mailto:ptavrow@umich.edu

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