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  • Print publication year: 2020
  • Online publication date: May 2020

4 - Constitutional Health System Design

from Part III - Political Institutions and Health


Health systems are part of a wider macro-level design establishing the principles and ‘rules of the game’ a society should be guided by. Such choices include principles that constrain policy choices to respect for human and economics rights. Such choices, in turn, influence the behaviour and expectations of the patient citizen (PC). The morphology of a health system is determined by so-called first-level choices,1 representaives of the PC make, in constitutional commissions and in Parliament. Among those first-level choices, one should highlight the delineation of how political power is shared horizontally (between the executive, judiciary and legislative branches of government). In making such first-level choices, countries are deemed to decide whether healthcare is regulated as a human right. Specifically, the right to the highest attainable standard of health which was included in the Constitution of the World Health Organization (WHO) back in 1946. However, the way this right to health is implemented and prioritised differs across countries, and we still know little about how constitutions, which define the basic institutions of a country, influence healthcare activity alongside the PC’s access to health services.

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