Those who can pay, should
Bruce Golding, whose administration removed user fees from Jamaican hospitals, accepts that, like any policy pursued by a government, this one is worthy of periodic review.
This newspaper, like one of Mr Golding's former ministers, Christopher Tufton, believes that the policy is in need of more than review, but urgent reversal. Indeed, that is the sentiment, too, of the vast majority of Jamaica's health professionals.
This bad programme, however, remains because of the current administration's fear of emotive arguments of the kind that Mr Golding, in between some worthy observations, unleashed so as to induce policy paralysis. So, we are told of a case at Cornwall Regional Hospital of a woman who was said to have died while her family tried to raise J$60,000 to pay for an emergency medical procedure. There are claims of people, because they couldn't afford hospital treatment, resorting to 'bush medicine' and dying of their illnesses.
Unfortunately, no empirical information is offered on the prevalence of such supposed cases.
No one, of course, presumes, as the health minister, Fenton Ferguson, seems to believe, that "user fees by itself is the solution to a sustainable health sector". But most people are acutely aware that even with an 18 per cent increase for the 2015-16 fiscal year, to J$47.8 billion, the recurrent budget for the public-health sector is substantially short of what is required.
In the circumstance, the Government, as Dr Tufton articulated recently in this newspaper, "may have no choice but to rethink its approach to public health-provision, which includes the re-examination of the no-user-fee policy in public hospitals". Indeed, as Dr Tufton reminded, the Simpson Miller administration previously indicated that that was a policy it would follow.
To be clear, we acknowledge the fact, as Mr Golding pointed out, of the large number of Jamaicans who live in poverty or are not far removed from it, as well as the difficulties inherent in designing and implementing credible means-testing mechanisms. We nonetheless see these as obstacles to be overcome, not to be detained by. In any event, an appropriate system would not only determine capacity to pay in health facilities, but be adapted and applied across the Government.
Further, we believe in the cumulative effect of even a little at a time. So, unlike Mr Golding, we would not be dismissive of a 20 per cent collection on hospital bills, which the former prime minister said was the case in the last fiscal year, 2007-8, before user fees were removed. In that year, the Government projected to collect more than J$1.7 billion in hospital fees, more than double the previous year. A 20 per cent collection would be approximately $350 million, unadjusted for inflation. That is not a sum to be sniffed at.
The larger point is that the delivery of quality health care has to be considered and achieved in the context of Jamaica's economic situation, including the Government's fiscal crisis and its need to tighten expenditure. Improved service delivery; greater utilisation of primary health facilities; education on prevention; and new, creative ways to fund the system must be on the agenda.
But people, where they can, should also pay their fair share.