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IU expert in health law examines increasing interconnectedness of North American health care

"If the Europeans can achieve universal health coverage across a continent, why can't we in the Western Hemisphere?" challenges Indiana University law professor Eleanor D. Kinney.

Kinney, one of our country's leading experts on health law and director of the William S. and Christine S. Hall Center for Law and Health at Indiana University School of Law-Indianapolis, was inspired through travels in Latin America and studies of European history.

In her work, she argues that the health sectors of the three North American countries -- the United States, Canada and Mexico -- are growing more integrated, and whether we like it or not, that we should think more intentionally about implications of this economic integration.

Eleanor Kinney

Eleanor Kinney

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With globalization, "medical tourism" has become an increasing trend. Some U.S. residents travel to Latin America for affordable health care services and health insurance; others are envious Canada's universal coverage. Some in Mexico and Canada do travel to the United States because of very specialized (and costly) services not available in other countries.

Kinney's article, "Health Care Financing and Delivery in the United States, Mexico, and Canada: Establishing Intentional Principles for Sound Integration," was recently published in the Wisconsin International Law Journal. It examines the process by which economic and health care collaboration occurred in the European Union, then provides similarities and contrasts to developing international agreements in North America. It then addresses major debates and obstacles to an integrated health care policy.

After years of economic integration, the European Union has adopted an unequivocal requirement that all member states have comprehensive health care coverage as must all states that aspire to join the EU. The free flow of individuals between member states has also led these states to develop coverage that is available in all parts of the European Union. Economic and population integration between North American countries is far less complete, placing less pressure on governments to address universal health protection.

Kinney responds to the most most obvious obstacle to integrated health care systems in North America: economic disparity between countries.

"For one thing, integration is happening with medical tourism and insurance moving across borders, among other developments. Such trends could have a big impact on U.S. health care providers. In addition, a real problem with illegal immigration is the challenges for health care providers who are called upon to treat uninsured immigrants," she says. "To solve these problems, we need to pay attention to the impact of economic integration and NAFTA (the North American Free Trade Agreement) on the health sectors of the three countries. We should be sure that in crafting trade policy, we don't undo sound health policy."

Kinney says she believes that the quality of medical care in some areas of Mexico would surprise most Americans. "It can be very good and cost a good deal less," she says.

Another major obstacle to integration is the extent of government involvement. Canada has nationally mandated health care coverage, while Mexico has private coverage for the elite and erratic state-sponsored coverage for others. We in the U.S. have a primarily private coverage, with public coverage only for vulnerable groups. These varying levels of coverage indicate a correlation between universal health coverage and health, as life expectancy and infant mortality are worst in Mexico and best in Canada.

Kinney believes that consensus on good health reform for NAFTA countries would be more likely with a government plan in addition to private plans. As it stands, the United States is the most discordant, with our emphasis on private coverage and market approaches.

This presents one of the fundamental debates in health care: Is it a commodity or a human right? Some argue that health care should be bought and sold in a market like any other good in order to promote the greatest efficiency. Others believe that access to health care is a inherent human right, and should be available to all citizens despite their ability to pay. A foundation for this belief is found in many major United Nations documents.

Kinney believes we can find a middle ground -- since most developed countries have some form of program to defray costs for their citizens and there are no developed countries in which health care is financed solely by the private funds of patients.

The fact that all developed countries have become involved in the health care services of their members indicates a failure in the free market, suggesting that government should play an important role, she says. The European Union's health care model provides a useful example from which we can learn when developing universal health care of our own.

About Eleanor D. Kinney

Eleanor D. Kinney has published widely on the health care system, and is the author or co-author of numerous law review articles, book chapters and book reviews on health law. She recently published Protecting American Health Care Consumers and edited the Guide to Medicare Coverage Decision-Making and Appeals.

She has also served as a consultant to the Administrative Conference of the United States, President Clinton's Task Force for Health Care Reform, and the Indiana Commission on Health Care for the Working Poor. She has been appointed by the governor of Indiana to the Executive Board of the Indiana State Department of Health and to other task forces and advisory boards. She currently serves as chair of the Patient Safety Subcommittee of the Indiana Commission on Excellence in Health Care.