Abstract
BackgroundThe aim of the study was a comparative analysis of legislative measures against discrimination in healthcare on the grounds of a) race and ethnicity, b) religion and belief, and c) gender identity and sexual orientation in Croatia, Germany, Poland and Slovenia.MethodsWe conducted a search for documents in national legal databases and reviewed legal commentaries, scientific literature and official reports of equality bodies. We integrated a comparative method with text analysis and the critical interpretive approach. The documents were examined in their original languages: Croatian, German, Polish, and Slovenian.ResultsAll examined states prohibit discrimination and guarantee the right to healthcare on the constitutional level. However, there are significant differences among them on the statutory level, regarding both anti-discriminatory legal measures and other legislation affecting access to healthcare for groups of diverse race or ethnicity, religion or belief, sexual orientation or gender identity. Croatia and Slovenia show the most comprehensive legislation concerning non-discrimination in healthcare in comparison to Germany and even more Poland. Except for Slovenia, explicit provisions protecting equal access for members of the abovementioned groups are insufficiently represented in healthcare legislation.ConclusionsThe study identified legislative barriers to access to healthcare for persons of diverse race or ethnicity, religion or belief, sexual orientation or gender identity in Croatia, Germany, Poland and Slovenia. The discrepancies in the level of implementation of anti-discriminatory measures among these states show that there is a need for comprehensive EU-wide regulations, which would implement the principle of equal treatment in the specific context of healthcare. General anti-discrimination regulations should be strengthened by inclusion of anti-discrimination provisions directly into national legislation relating specifically to the area of healthcare.
Highlights
The aim of the study was a comparative analysis of legislative measures against discrimination in healthcare on the grounds of a) race and ethnicity, b) religion and belief, and c) gender identity and sexual orientation in Croatia, Germany, Poland and Slovenia
Amartya Sen observed that health equity, is “a multidimensional concept” and ought to be seen as an aspect of the general area of social justice. [3] (p. 26, 31) he said that “nondiscrimination in the delivery of health care” is still of vital importance. [3] (p. 31) Such multidimensional approach was adopted in 2000 by the United Nations Committee on Economic, Social and Cultural Rights, which stated that the right to health is understood “as an inclusive right extending to timely and appropriate health care and to the underlying determinants of health.”
Ruger offers “a capability perspective” on equal access to healthcare, which is not limited to distribution of healthcare, but includes concerns about “healthcare quality, health agency, and health norms.” [6] (p. 92) Ruger claims that when thinking about equal access to healthcare, we should go beyond the horizon of legal norms and focus on public moral norms
Summary
The aim of the study was a comparative analysis of legislative measures against discrimination in healthcare on the grounds of a) race and ethnicity, b) religion and belief, and c) gender identity and sexual orientation in Croatia, Germany, Poland and Slovenia. [1] The issue of access to healthcare as a social good sparked the interests of philosophers of social justice in the 1970s focusing on equity in healthcare understood as access to physicians, geographical proximity, and economic status. These discussions did not tackle the issue of diversity. Norman Daniels observed that healthcare is a special social good, as health is a condition of equal opportunities. Drawing on Martha Nussbaum’s and Sen’s ideas, J.P. Ruger offers “a capability perspective” on equal access to healthcare, which is not limited to distribution of healthcare, but includes concerns about “healthcare quality, health agency, and health norms.” [6] In spite of its non-systemic character and even ambiguity, this kind of action can “correct discrimination and unequal treatment.” [7] (p. 235)
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