Editorial | Dr Tufton’s dilemma
Perhaps the most profound of Health Minister Christopher Tufton's observations during a review of his portfolio in Parliament on Wednesday was an implicit admission that the Jamaican Government cannot afford to fund its health service to deliver the quality expected, and deserved, by citizens.
Or, as Dr Tufton framed the issue, "the Government's capacity to adequately finance public health care will increasingly be challenged, unless we are able to grow our economy well beyond our current rate of growth".
For this fiscal year, the Government has budgeted to spend approximately J$53 billion on health services, the same amount as in 2015-16, which, after accounting for inflation, represents a decline, in real terms, of more than four per cent. That expenditure, the health minister noted, is around 3.3 per cent of the value of the national output of goods and services, or gross domestic product. But when the spending of private-sector providers is added, the expenditure rises to 5.9 per cent of GDP.
The World Health Organization (WHO), though, recommends that health expenditure should be around eight per cent of GDP, the amount committed by Britain, which is two percentage points behind Canada's. In some developed countries, the level is much higher.
Dr Tufton's observations are critical on two counts. One of these is the political dilemma is poses for Andrew Holness' government. The other, and related point, assuming that Dr Tufton did not speak out of turn, is its need to open, and properly manage, a serious conversation on the matter, aimed at arriving at a consensus on the way forward.
On the first point, the policy, as we understand it, is that people who utilise public health facilities, which is to say those owned by the Government, are not required to pay - the so-called 'no-user-fee' policy. Previously, people were asked to pay for some services at public hospitals, although no one was supposed to be turned back if they couldn't afford to pay, and services carried huge arrears. The perhaps J$2 billion that was collected up 2008 contributed no insignificantly to the maintenance of the sector. User fees, however, were eliminated by the previous Jamaica Labour Party (JLP) administration in which Mr Tufton served, a policy that was continued by the PNP government that succeeded it, and was perceived to be among the central planks of the JLP when it returned to office this past February, similar to its removal of mandatory 'cost-sharing' in high schools.
The Government's argument for the policy, as it has been for cost-sharing in high schools, is to ensure universal access to health, which, unfortunately, often means the overburdening of hospitals, to the exclusion of primary and secondary health-delivery systems.
Dr Tufton says the administration remains committed to universal access, but concedes that what this means has to be more clearly defined, giving the varying interpretations among stakeholders, which sometimes lead to "disappointments and frustrations". Perhaps more to the point, in the short to medium term, there has to be a walking back of expectations. That is the responsibility of the Government.
Given the unlikelihood of Jamaica quickly achieving the levels of growth for the Government to adequately fund health care, the emphasis has to be on efficiency, preventative medicine and bringing private money to the system. The task force, chaired by Chris Zacca, on establishing a national health insurance scheme is a move in the right direction.