[Re: https://www.hifa.org/dgroups-rss/open-access-59-experience-oa-healthcare... ]
Hi Neil,
Great question. As someone with the privilege of working in universities in high-income countries, I've virtually never been unable to access a subscription-only article. The universities and hospitals subscribe to large numbers of journals, usually through package deals with publishers which do indeed have the benefit of allowing smaller less-profitable journals to survive. On those occasions where an article or journal was not available, our libraries can generally get access to virtually any article (or book) by borrowing from a partner university through an inter-library loan. This may take a few extra days for an article but access is almost always available, so ultimately it hasn't been a real problem yet, at least for large American universities as far as I have seen.
The cost of these university packages continues to increase and much has been written about how difficult it is for university library budgets to keep supporting these, which is especially ironic since it is often the same university researchers that are producing the content that goes into those journals, research that is often publicly funded itself. A vicious circle that has led to some high-profile disagreements between universities and publishers. It is not clear how these conflicts will play out, but one approach here has been for the university to set up agreements with certain publishers for the university to pay for their researchers' open-access fees instead of, or in addition to, paying for the subscription costs to the journals.
cheers,
indi
HIFA profile: Indi Trehan is a physician-scientist and academic researcher based in Seattle, United States. He is a professor of paediatrics at Seattle Children's Hospital; adjunct professor of global health and epidemiology at University of Washington; investigator at UW Global Center for Integrated Health of Women, Adolescents, and Children; and investigator at Seattle Children's Research Institute Center for Clinical and Translational Research. He has published in many different journals, some open, some hybrid, some closed. He has run into the various issues with trying to get funding for open publishing access. He is also an editor at multiple journals and has mentored many junior researchers in both HICs and LMICs on how to navigate open access issues. He is a member of the HIFA Project on Open Access. https://www.hifa.org/support/members/indi indi AT alum.berkeley.edu