Editorial | Who pays for health care
If Christopher Tufton did nothing else during his ministerial reporting to Parliament last week, he again afforded the Holness administration another opportunity to advance a mature, depoliticised debate on the financing of health care and what Jamaicans should expect for what they pay.
As in other countries, health care is often a politically emotive subject. In 2007, the promise of 'free' health care contributed to the election victory of Dr Tufton's Jamaica Labour Party (JLP). It wasn't surprising that when the People's National Party (PNP) took back the government in 2011, it didn't, despite the impracticability of the policy in Jamaica's economic situation, reverse the initiative.
The outcome was predictable.
Allocations to the health sector have, in real terms, been insufficient to offset what was lost from those who used to pay, or to keep up with the rising cost of health services. As more people turned up at supposedly totally free public health-care facilities, staff became more overworked, service quality declined further, and patients became increasingly frustrated over long waits.
A survey for this newspaper last September found that 75 per cent of Jamaicans did not believe they had access to quality care. The majority of this group argued that people needed money to acquire good health services.
Patients who complained about the quality of service at public institutions were angry about long waits, as well as the state of disrepair of facilities and the inadequacy of equipment.
For this fiscal year, the Government plans to spend J$61.3 billion on health services, or around five per cent more than in 2016-17. That, despite the top-ups provided by auxiliary agencies, is not enough to pay for what is required. What the Jamaican Government spends on health care is not much above half of the six per cent of GDP recommended by the World Health Organization. There is clearly need for rational discussion on how the country can deliver health care in a manner that the poor and vulnerable are not priced out of the system.
Last year, Dr Tufton, than the new health minister, essayed at the problem, warning that "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". He would have understood that the level of growth needed to generate the surpluses to adequately fund a state-run, single-payer health system wasn't in the immediate offing. Or even the medium term.
Last week, he was frank and forthright about what the system can deliver in the present fiscal circumstance, noting that taking responsibility for one's health also "means contributing to your health-care costs once you are in a position to contribute".
The issue, therefore, is the model by which those who can afford to pay for utilising the public health-care system are asked to do so. Dr Tufton has reprised the idea of a national health insurance scheme, first raised in the late 1990s, but stumbled on structure and affordability. Perhaps now the kinks have been worked out. Other suggestions, though, include means-testing to determine who can afford to pay.
A potential problem for Dr Tufton is convincing his government colleagues of the worth and efficacy of a retreat from a policy that brought political dividends. For now, he may just have to singularly bear the burden of carrying the argument.