Editorial | Broaden pharmacy debate
The picture painted by Milton Wray of a state behemoth trampling Jamaica's pharmacies, the National Health Fund (NHF) insists, is the product of an overheated imagination.
Mr Wray, however, may have ignited a worthy debate on how, and if, government agencies ought to operate in private markets and what precisely should be the role of the NHF and the state of its study of how Jamaica might create a national health insurance scheme, an idea contemplated by the law.
The recently published findings by the auditor general of her department's audit of the NHF add, we believe, to the timeliness of this discussion.
The NHF is the creature of a 2003 law that provides for the Government to allocate 20 per cent of the special consumption tax levied on tobacco products; five per cent of general consumption taxes; and 0.5 per cent of National Insurance Scheme (NIS), up to J$500,000, towards paying for drugs for persons with non-communicable lifestyle diseases.
Primarily, individuals with prescribed diseases can get an NHF card, through which the agency co-pays for their drugs. There is an allied scheme for the elderly, but with better terms for the patient.
According to the NHF's CEO Everton Anderson in a guest column published in today's edition, the Fund has 370,000 beneficiaries, 42 per cent of them elderly. Since 2003, the fund has spent around J$31 billion for the provision of drugs, including J$4.2 billion for the financial year up to the end of March 2017.
But according to Mr Wray, a pharmacy owner and former entertainment journalist, the NHF is pushing private pharmacies out of business by providing free and subsidised drugs "even to the rich and those covered under private health insurance". In other words, the NHF, a public agency, Mr Wray argues, is unfairly competing with private pharmacies, especially through its expanded Drug Serv outlets that provide free prescription cover not only to patients of public clinics but also private doctors.
At least in part, the premise of Mr Wray's claim seems a bit less than solid. For on the face of it, while holders of NHF cards receive a subsidy for their drugs, the pharmacies that dispense the drugs ought not to be out of pocket. They are to be paid by the NHF the difference of what the patients pay and the cost of the drug.
Mr Wray may have a point about the expanded role of the Drug Serv outlets, if, in fact, their role has been expanded to provide drugs free of cost to patients of the public and private system, regardless of ability to pay, which the NHF says is not the case.
Mr Anderson says that of the 1.4 million prescriptions filled by Drug Serv pharmacies in 2016-17, only five per cent were from private patients. Those approximately 70,000 prescriptions would be mostly for drugs that private pharmacies do not generally stock because they are slow-moving, expensive and/or difficult to source.
If nothing else, Mr Wray displayed courage by making his concerns public. The NHF has responded through Mr Anderson. We look forward to other stakeholders, including pharmacy owners, joining the debate and expanding it on at least two other fronts.
One of these is the Government's 2011 decision to fold the National Health Corporation (NHC), a procurement, distribution and retail operation into the NHF, which was primarily a financial outfit. The NHF inherited the Drug Serv entities and now has to involve itself in matters such as inventory management and product distribution, and is finding itself, as the auditor general's report indicated, confronting some of the same issues that bedevilled the NHC. Outsourcing these functions to the private sector, linking remuneration with efficiency, might be worth considering.
The larger and underlying issue is the affordability of health care for Jamaicans, with only about a third of the workforce having health insurance and the Government's inability to adequately fund the health system. The Holness administration, more than a year ago, tasked then NHF Chairman Chris Zacca to figure out if a national health insurance scheme might work. It's time for an update.