The Role of Constitutional Courts in Promoting Healthcare Equity: Lessons from Hungary
DOI:
https://doi.org/10.31078/consrev624Keywords:
Right to Health, Constitutional Litigation, Healthcare EquityAbstract
This paper explores whether constitutional litigation contributes to sustaining the equity element of the right to health. Equity entails a fair distribution of the burden of healthcare financing across the different socio-economic groups of the population. A shift towards uncontrolled private healthcare provision and financing raises equity challenges by disproportionately benefitting those who are able to afford such services. The extent to which equity is enforced is an indicator of the strength of the right to health. However, do domestic constitutional courts second-guess, based on equity, policy decisions that impact on healthcare financing? Is it the task of constitutional courts to scrutinize such policy decisions? Under what conditions are courts more likely to do so? The paper addresses these questions by focusing on the case of Hungary, where the right to health has been present in the Fundamental Law adopted in 2010 and the Constitutions preceding it. While the Hungarian Constitutional Court has been traditionally cautious to review policy decisions pertaining to healthcare financing, the system has been struggling with equity issues and successive government coalitions have had limited success in tackling these. The paper discusses the role of constitutional litigation in addressing such equity concerns. In doing so, it contributes to the discussion on the role of domestic constitutional courts in the protection of social and economic rights.References
Act LXIII of 1996 on The Obligation of Healthcare Delivery and Rules of Territorial Financing (1996. évi XXXII. törvény az egészségügyi ellátási kötelezettségről és a területi finanszírozási normatívákról) (Hung.).
Act CLIV of 1997 on Health (1997. évi CLIV. törvény az egészségügyről) (Hung.).
Act LXXX of 1997 on Persons Entitled to Social Insurance Services and Private Pension and the Financing of These Services (1997. évi LXXX. törvény a társadalombiztosítás ellátásaira és a magánnyugdíjra jogosultakról, valamint e szolgáltatások fedezetéről) (Hung.).
Act LXXXIII of 1997 on Services of Compulsory Health Insurance (1997. évi
LXXXIII. Törvény a kötelező egészségbiztosítás ellátásairól) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 1995. 43/1995. (VI. 30.) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 1995. 56/1995. (IX. 15.) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 1996. 54/1996. (XI. 30.) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 2003. 517/B/2003. (XII. 12.) (Hung.).
Alkotmánybíróság (AB) elnöki végzés [Decision of the President of the Constitutional Court], MK. 2007. 179/I/2007. (IV. 6.) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 2018. 3197/2018. (VI. 21.) (Hung.).
Andia, Tatiana and Everaldo Lamprea. “Is the Judicialization of Health Care Bad for Equity? A Scoping Review.” International Journal for Equity in Health 18 (2019): 61-67.
Baji, Petra et al. “Informal Payments for Healthcare Services and Short‐Term Effects of the Introduction of Visit Fee on These Payments in Hungary.” The International Journal of Health Planning and Management 27, no. 1 (2011).
Council of the European Union. Council Conclusions on common values and principles in European Union health systems, Official Journal C-146/1-3, 2006.
European Commission. Establishing a European Pillar of Social Rights, 26.4.2017, COM(2017) 250 final.
European Parliament. “European Pillar of Social Rights.” Access 6 November 2019.
/https://ec.europa.eu/commission/sites/beta-political/files/social-summiteuropean-pillar-social-rights-booklet_en.pdf.
Ezat, Sharifa Wan Puteh and Yasmin Almualm. “Catastrophic Health Expenditure Among Developing Countries.” Health Research Policy and Systems 4, no. 1 (2017). DOI:10.21767/2254-9137.100069.
Flood, Colleen. “Litigating Health Rights in Canada: A White Knight for Equity?” In Comparative Health Rights at the Public/Private Divide, edited by Colleen Flood and Aeyal Gross. Cambridge: Cambridge University Press, 2014.
Flood, Colleen and Aeyal Gross. “Litigating the Right to Health: What Can We Learn from a Comparative Law and Health Care Systems Approach.” Health and Human Rights 16, no 2 (2014): E62-72.
Flood, Colleen M. and Aeyal Gross. “Introduction: Marrying Human Rights and Health Care Systems: Contexts for a Power to Improve Access and Equity.” In Comparative Health Rights at the Public/Private Divide, edited by Flood, Colleen M. and Aeyal Gross. Cambridge: Cambridge University Press, 2014.
Flood, Colleen and Aeyal Gross, ed., Comparative Health Rights at the Public/Private Divide. Cambridge: Cambridge University Press, 2014.
Földes, Mária Éva. “Revisiting Patients’ Rights to Information in an Enlarged Europe: A review of the Romanian and Hungarian Regulatory Framework in the Light of European Union Rules.” Orvostudományi Értesítő (Bulletin of Medical Sciences) 83, no. 2 (2010).
Földes, Mária Éva. “Addressing Equity in Health Care at the Public-Private Intersection: The Role of Health Rights Enforcement in Hungary.” In The Right to Health at the Public/Private Divide: A Global Comparative Study, edited by Colleen M. Flood and Aeyal Gross. Cambridge: Cambridge University Press, 2014.
Földes, Mária Éva. “Health Policy and Health Systems: A Growing Relevance for the EU in the Context of the Economic Crisis.” Journal of European Integration 38, no. 3 (2016).
Földes, Mária Éva. “Health Policy and Health Systems: A Growing Relevance for the EU in the Context of the Economic Crisis.” Journal of European Integration 38, no. 3 (2016).
Földes, Mária Éva. “Member State Interests and European Union Law: The Case of Health Policy and Health Systems.” In Between Compliance and Particularism: Member State Interests and European Union Law, edited by Márton Varju. Springer, 2019.
Government Decree No 43/1999. (III. 3.) on Detailed Rules Concerning the Financing of Healthcare Services from the Health Insurance Fund (Az egészségügyi szolgáltatások Egészségbiztosítási Alapból történő finanszírozásának részletes szabályairól szóló 43/1999. (III. 3.) Korm. Rendelet) (Hung.).
Greer, Scott et al. “Everything You Always Wanted to Know about European Union Health Policies but were Afraid to Ask,” 2nd edition. World Health Organization, Health policy series 54, 2019.
International Covenant on Economic, Social and Cultural Rights (ICESCR), G.A.
Res. 22001 (XXI), U.N. GAOR, 21st Sess., Supp. No 16, U.N. Doc A/6316, 993 U.N.T.D. 3 (1996).
Jung, Courtney, Ran Hirschl and Evan Rosevear. “Economic and Social Rights in National Constitutions.” American Journal of Comparative Law 62, no. 4 (2014).
Lamprea, Everaldo. “Colombia’s Right-to-Heath Litigation in a Context of Health Care Reform.” In Comparative Health Rights at the Public/Private Divide, edited by Colleen Flood and Aeyal Gross (Cambridge: Cambridge University Press, 2014).
Lamprea, Everaldo. “The Judicialization of Health Care: A Global South Perspective.” Annual Review of Law and Social Science 13 (2017).
Lopes, Luciana De Melo Nunes et al. “(Un)Equitable Distribution of Health Resources and the Judicialization of Healthcare: 10 Years of Experience in Brazil.” International Journal for Equity in Health 18 (2019): 10.
Martinsen, Dorte Sindbjerg. “Conflict and Conflict Management in the Crossborder Provision of Healthcare Services.” West European Politics 32, no. 4 (2009).
Mercier, Gregoire et al. “Out-of-Pocket Payments, Vertical Equity and Unmet Medical Needs in France: A National Multicenter Prospective Study on Lymphedema.” PLoS ONE 14, no. 5 (2019): e0216386. https://doi.org/10.1371/journal.pone.0216386.
Ministerial Decree No 32/2004 (IV. 26) on Criteria for Inclusion in Social Insurance Coverage of Authorized Medicinal Products and Food Supplements and on Changing Inclusion or Coverage (32/2004. (IV. 26.) (ESzCsM rendelet a törzskönyvezett gyógyszerek és a különleges táplálkozási igényt kielégítő tápszerek társadalombiztosítási támogatásba való befogadásának szempontjairól és a befogadás vagy a támogatás megváltoztatásáról) (Hung.).
Ministerial Decree No 14/2007 (III. 14.) on Inclusion in Social Insurance Coverage of Medical Aids and Coverage of Their Prescription, Supply, Reparation and Borrowing (14/2007. (III. 14.) EüM rendelet a gyógyászati segédeszközök társadalombiztosítási támogatásba történő befogadásáról, támogatással történő rendeléséről, forgalmazásáról, javításáról és kölcsönzéséről) (Hung.).
National Healthcare Services Center. Health System Performance Assessment 2013-2015 (Állami Egészségügyi Ellátó Központ, Magyar Egészségügyi Rendszer Teljesítményértékelési Jelentése 2013-15). December, 2016.
OECD. Health at a Glance 2019: OECD Indicators. Paris: OECD Publishing, 2019.
Sándor, Judit. “Ombudspersons and Patients’ Rights Representatives in Hungary.” In Protecting Patients’ Rights? A Comparative Study of the in Healthcare, edited by Stephen Mackenney and Lars Fallberg. CRC Press, 2002.
Szende, Agota and Anthony Johr Culyer. “The Inequity of Informal Payments for Health Care: The Case of Hungary.” Health Policy 75, no. 3 (2006).
The Constitution of the People’s Republic of Hungary, Act XX of 1949 (1949. évi XX. törvény, a Magyar Népköztársaság Alkotmánya) (Hung.).
The Amendment of the Constitution, Act XXXI of 1989 (1989. évi XXXI. törvény az Alkotmány módosításáról) (Hung.).
The Constitutional Court, Act XXXII of 1989 (1989. évi XXXII. törvény az Alkotmánybíróságról) (Hung.).
United Nations Committee on Economic, Social and Cultural Rights (CESCR), General Comment No 14, The Right to the Highest Attainable Standard of Health, UN Doc. No E/C.12/2000/4 (2000).
Vargas-Pelaez, Claudia Marcela et al. “Right to Health, Essential Medicines, and Lawsuits for Access to Medicines - A Scoping Study.” Social Science & Medicine 121 (2014).
Vargas-Pelaez, Claudia Marcela et al. “Judicialization of Access to Medicines in Four Latin American Countries: A Comparative Qualitative Analysis.” International Journal for Equity in Health 18 (2019): 68.
World Health Organization. The World Health Report: 2000 : Health systems: improving performance. World Health Organization, 2000. https://apps.who.int/iris/handle/10665/42281 (last accessed on 14 November 2019).
Act CLIV of 1997 on Health (1997. évi CLIV. törvény az egészségügyről) (Hung.).
Act LXXX of 1997 on Persons Entitled to Social Insurance Services and Private Pension and the Financing of These Services (1997. évi LXXX. törvény a társadalombiztosítás ellátásaira és a magánnyugdíjra jogosultakról, valamint e szolgáltatások fedezetéről) (Hung.).
Act LXXXIII of 1997 on Services of Compulsory Health Insurance (1997. évi
LXXXIII. Törvény a kötelező egészségbiztosítás ellátásairól) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 1995. 43/1995. (VI. 30.) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 1995. 56/1995. (IX. 15.) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 1996. 54/1996. (XI. 30.) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 2003. 517/B/2003. (XII. 12.) (Hung.).
Alkotmánybíróság (AB) elnöki végzés [Decision of the President of the Constitutional Court], MK. 2007. 179/I/2007. (IV. 6.) (Hung.).
Alkotmánybíróság (AB) [Constitutional Court], MK. 2018. 3197/2018. (VI. 21.) (Hung.).
Andia, Tatiana and Everaldo Lamprea. “Is the Judicialization of Health Care Bad for Equity? A Scoping Review.” International Journal for Equity in Health 18 (2019): 61-67.
Baji, Petra et al. “Informal Payments for Healthcare Services and Short‐Term Effects of the Introduction of Visit Fee on These Payments in Hungary.” The International Journal of Health Planning and Management 27, no. 1 (2011).
Council of the European Union. Council Conclusions on common values and principles in European Union health systems, Official Journal C-146/1-3, 2006.
European Commission. Establishing a European Pillar of Social Rights, 26.4.2017, COM(2017) 250 final.
European Parliament. “European Pillar of Social Rights.” Access 6 November 2019.
/https://ec.europa.eu/commission/sites/beta-political/files/social-summiteuropean-pillar-social-rights-booklet_en.pdf.
Ezat, Sharifa Wan Puteh and Yasmin Almualm. “Catastrophic Health Expenditure Among Developing Countries.” Health Research Policy and Systems 4, no. 1 (2017). DOI:10.21767/2254-9137.100069.
Flood, Colleen. “Litigating Health Rights in Canada: A White Knight for Equity?” In Comparative Health Rights at the Public/Private Divide, edited by Colleen Flood and Aeyal Gross. Cambridge: Cambridge University Press, 2014.
Flood, Colleen and Aeyal Gross. “Litigating the Right to Health: What Can We Learn from a Comparative Law and Health Care Systems Approach.” Health and Human Rights 16, no 2 (2014): E62-72.
Flood, Colleen M. and Aeyal Gross. “Introduction: Marrying Human Rights and Health Care Systems: Contexts for a Power to Improve Access and Equity.” In Comparative Health Rights at the Public/Private Divide, edited by Flood, Colleen M. and Aeyal Gross. Cambridge: Cambridge University Press, 2014.
Flood, Colleen and Aeyal Gross, ed., Comparative Health Rights at the Public/Private Divide. Cambridge: Cambridge University Press, 2014.
Földes, Mária Éva. “Revisiting Patients’ Rights to Information in an Enlarged Europe: A review of the Romanian and Hungarian Regulatory Framework in the Light of European Union Rules.” Orvostudományi Értesítő (Bulletin of Medical Sciences) 83, no. 2 (2010).
Földes, Mária Éva. “Addressing Equity in Health Care at the Public-Private Intersection: The Role of Health Rights Enforcement in Hungary.” In The Right to Health at the Public/Private Divide: A Global Comparative Study, edited by Colleen M. Flood and Aeyal Gross. Cambridge: Cambridge University Press, 2014.
Földes, Mária Éva. “Health Policy and Health Systems: A Growing Relevance for the EU in the Context of the Economic Crisis.” Journal of European Integration 38, no. 3 (2016).
Földes, Mária Éva. “Health Policy and Health Systems: A Growing Relevance for the EU in the Context of the Economic Crisis.” Journal of European Integration 38, no. 3 (2016).
Földes, Mária Éva. “Member State Interests and European Union Law: The Case of Health Policy and Health Systems.” In Between Compliance and Particularism: Member State Interests and European Union Law, edited by Márton Varju. Springer, 2019.
Government Decree No 43/1999. (III. 3.) on Detailed Rules Concerning the Financing of Healthcare Services from the Health Insurance Fund (Az egészségügyi szolgáltatások Egészségbiztosítási Alapból történő finanszírozásának részletes szabályairól szóló 43/1999. (III. 3.) Korm. Rendelet) (Hung.).
Greer, Scott et al. “Everything You Always Wanted to Know about European Union Health Policies but were Afraid to Ask,” 2nd edition. World Health Organization, Health policy series 54, 2019.
International Covenant on Economic, Social and Cultural Rights (ICESCR), G.A.
Res. 22001 (XXI), U.N. GAOR, 21st Sess., Supp. No 16, U.N. Doc A/6316, 993 U.N.T.D. 3 (1996).
Jung, Courtney, Ran Hirschl and Evan Rosevear. “Economic and Social Rights in National Constitutions.” American Journal of Comparative Law 62, no. 4 (2014).
Lamprea, Everaldo. “Colombia’s Right-to-Heath Litigation in a Context of Health Care Reform.” In Comparative Health Rights at the Public/Private Divide, edited by Colleen Flood and Aeyal Gross (Cambridge: Cambridge University Press, 2014).
Lamprea, Everaldo. “The Judicialization of Health Care: A Global South Perspective.” Annual Review of Law and Social Science 13 (2017).
Lopes, Luciana De Melo Nunes et al. “(Un)Equitable Distribution of Health Resources and the Judicialization of Healthcare: 10 Years of Experience in Brazil.” International Journal for Equity in Health 18 (2019): 10.
Martinsen, Dorte Sindbjerg. “Conflict and Conflict Management in the Crossborder Provision of Healthcare Services.” West European Politics 32, no. 4 (2009).
Mercier, Gregoire et al. “Out-of-Pocket Payments, Vertical Equity and Unmet Medical Needs in France: A National Multicenter Prospective Study on Lymphedema.” PLoS ONE 14, no. 5 (2019): e0216386. https://doi.org/10.1371/journal.pone.0216386.
Ministerial Decree No 32/2004 (IV. 26) on Criteria for Inclusion in Social Insurance Coverage of Authorized Medicinal Products and Food Supplements and on Changing Inclusion or Coverage (32/2004. (IV. 26.) (ESzCsM rendelet a törzskönyvezett gyógyszerek és a különleges táplálkozási igényt kielégítő tápszerek társadalombiztosítási támogatásba való befogadásának szempontjairól és a befogadás vagy a támogatás megváltoztatásáról) (Hung.).
Ministerial Decree No 14/2007 (III. 14.) on Inclusion in Social Insurance Coverage of Medical Aids and Coverage of Their Prescription, Supply, Reparation and Borrowing (14/2007. (III. 14.) EüM rendelet a gyógyászati segédeszközök társadalombiztosítási támogatásba történő befogadásáról, támogatással történő rendeléséről, forgalmazásáról, javításáról és kölcsönzéséről) (Hung.).
National Healthcare Services Center. Health System Performance Assessment 2013-2015 (Állami Egészségügyi Ellátó Központ, Magyar Egészségügyi Rendszer Teljesítményértékelési Jelentése 2013-15). December, 2016.
OECD. Health at a Glance 2019: OECD Indicators. Paris: OECD Publishing, 2019.
Sándor, Judit. “Ombudspersons and Patients’ Rights Representatives in Hungary.” In Protecting Patients’ Rights? A Comparative Study of the in Healthcare, edited by Stephen Mackenney and Lars Fallberg. CRC Press, 2002.
Szende, Agota and Anthony Johr Culyer. “The Inequity of Informal Payments for Health Care: The Case of Hungary.” Health Policy 75, no. 3 (2006).
The Constitution of the People’s Republic of Hungary, Act XX of 1949 (1949. évi XX. törvény, a Magyar Népköztársaság Alkotmánya) (Hung.).
The Amendment of the Constitution, Act XXXI of 1989 (1989. évi XXXI. törvény az Alkotmány módosításáról) (Hung.).
The Constitutional Court, Act XXXII of 1989 (1989. évi XXXII. törvény az Alkotmánybíróságról) (Hung.).
United Nations Committee on Economic, Social and Cultural Rights (CESCR), General Comment No 14, The Right to the Highest Attainable Standard of Health, UN Doc. No E/C.12/2000/4 (2000).
Vargas-Pelaez, Claudia Marcela et al. “Right to Health, Essential Medicines, and Lawsuits for Access to Medicines - A Scoping Study.” Social Science & Medicine 121 (2014).
Vargas-Pelaez, Claudia Marcela et al. “Judicialization of Access to Medicines in Four Latin American Countries: A Comparative Qualitative Analysis.” International Journal for Equity in Health 18 (2019): 68.
World Health Organization. The World Health Report: 2000 : Health systems: improving performance. World Health Organization, 2000. https://apps.who.int/iris/handle/10665/42281 (last accessed on 14 November 2019).
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2020-12-30
How to Cite
Éva Földes, M. (2020). The Role of Constitutional Courts in Promoting Healthcare Equity: Lessons from Hungary. Constitutional Review, 6(2), 282–310. https://doi.org/10.31078/consrev624
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