Tue | Apr 7, 2020

Garth Rattray | Confused about no-user-fee policy

Published:Monday | August 20, 2018 | 12:00 AM

This piece recently appeared in The Gleaner: 'User fees for health facilities to go up August 1'. "Persons with health insurance, non-residents, and private patients will pay more to access services at public health facilities starting August 1. The Ministry of Health is advising that the cost of registration when visiting a medical facility will move from $1,500 to $3,000, and it will cost $7,500, up from $3,500, to visit speciality clinics.

"... Jamaicans who do not fall in any of the above-mentioned categories, that is, public patients without health insurance, will continue to access the public health services without charge, in keeping with the abolition of user fees for public health facilities that took effect in 2008."

The no-user-fee service is no longer totally abolished. Someone took political advantage of the fact that only a small percentage of patients accessing the public health system were paying their fees. The no-user-fee system was a huge component of the political campaign.

Strangely, no one checked to see how much was being earned from the few who paid their user fees; it was a whopping $1.7 billion annually. Since effectively throwing away that annual income (beginning April 1, 2008), the healthcare system suffered serious financial shortfalls and caused untold suffering and deaths of some poor citizens.

In trying to validate that horrible faux pas, the administration quoted a United Nations document (The Report on the World Social Situation 2010). It stated, "Most key players in the health arena now recognise that user fees constitute a significant barrier to access to health services. ... Removing user fees has proved to be an effective strategy for increasing access to healthcare."




However, they failed to quote the very next paragraph of the same report: "At the same time, removing fees will entail additional resource requirements. It is, therefore, important to ensure that additional funding is available for countries that want to remove fees. To support the permanent removal of user fees and to ensure that the poor benefit from such actions, fee removal needs to be part of a broader package of reforms that includes increased budgets to offset lost fee revenue."

Then there was this damning World Bank report (Realising Rights Through Social Guarantees: The Case of Jamaica ... The challenge of social service provision in the political arena) ... . "Notwithstanding the improvements in the system, increased utilisation of public health provision, and removal of user fees, there is evidence to suggest that the health system continues to function below the level of demand for healthcare in Jamaica.

"... Therefore, because the removal of user fees was not accompanied by adjustments to capacity, there is, therefore, some danger that this policy may have no real impact on improving access to healthcare in Jamaica."

Instead of rescinding the no-user-fee policy and implementing across-the-board fees and encouraging patients to pay what they can afford, the Government is making the health insurance industry subsidise the system. However, according to health insurance rules/regulations, policyholders must be subject to the same fee structure as those who do not have any health insurance.

Although it costs healthcare providers when patients swipe their health insurance cards, we are not allowed to charge patients with health insurance more than patients without health insurance. Violation of that clause could result in termination of our agreement with the health insurance company. Are the rules/regulations for the Government different from those for private healthcare providers?

Regarding private fees, doctors are not allowed to manage their private patients through the public system. Patients are either private OR public. So, why are private patients' fees quoted in the public fee structure?

I am confused about the no-user-fee system. I hope someone will explain these incongruities.

- Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.