Project Director, UHC Policy Forum, Centre on Global Health Security
Tom BrookesProgramme Officer, The Elders
Eloise WhitakerFormer Fellow, Improving Global Health through Leadership Development Programme, Thames Valley and Wessex NHS Leadership Academy

A new paper assesses the prevalence of medical detentions globally, the health and human rights impacts, and policy options to reduce and eradicate the practice.

Women admitted to the maternity ward at Roi Baudoin hospital in Kinshasa, Democratic Republic of the Congo, are counselled by a staff member on 3 March 2010, after having been detained at the hospital for non-payment of medical fees. Photo: AFP/Getty.Women admitted to the maternity ward at Roi Baudoin hospital in Kinshasa, DRC, are counselled by staff after having been detained for non-payment of medical fees. Photo: Getty Images.

Summary

  • In some parts of the world it is common practice for patients to be detained in hospital for non-payment of healthcare bills.
  • Such detentions occur in public as well as private medical facilities, and there appears to be wide societal acceptance in certain countries of the assumed right of health providers to imprison vulnerable people in this way.
  • The true scale of these hospital detention practices, or ‘medical detentions’, is unknown, but the limited academic research to date suggests that hundreds of thousands of people are likely to be affected every year, in several sub-Saharan African countries and parts of Asia. Women requiring life-saving emergency caesarean sections, and their babies, are particularly vulnerable to detention in medical facilities.
  • Victims of medical detention tend to be the poorest members of society who have been admitted to hospital for emergency treatment, and detention can push them and their families further into poverty. They may also be subject to verbal and/or physical abuse while being detained in health facilities.
  • The practice of detaining people in hospital for non-payment of medical bills deters healthcare use, increases medical impoverishment, and is a denial of international human rights standards, including the right not to be imprisoned as a debtor, and the right to access to medical care.
  • At the root of this problem are the persistence of health financing systems that require people to make high out-of-pocket payments when they need healthcare, and inadequate governance systems that allow facilities to detain patients.
  • Universal health coverage (UHC) cannot be achieved while people are experiencing financial hardship through their inability to pay for healthcare, so by definition any country that allows medical detention is failing to achieve UHC.
  • Health financing systems should be reformed by moving towards publicly financed UHC, based on compulsory progressive pre-payment mechanisms. This would enable hospitals to become financially sustainable without the need to charge significant user fees.