Wed | Mar 21, 2018

Strengthen public-private partnerships to improve healthcare services

Published:Wednesday | March 2, 2016 | 12:00 AMDr Alfred Dawes


The Government, via a public-health system, and the private medical sector, provides health care to the population. A country's overall health-care expenditure is a sum of the contribution of both private and Government expenditure. In some countries, the private sector contributes the larger chunk of the health-care dollars spent, while in others it is the Government that is the leading provider of health care.

The United States, with the highest expenditure per capita on health in the world, is a prime example of the former. The US spends US$9,156 per person per year (2013 figures), with approximately 53 per cent of this expenditure from the private sector, the main driver of the ballooning of healthcare costs in that country.

Canada, on the other hand, has a system whereby the private sector is essentially dependent on the Government's health policy for survival. The majority of the US$5718 spent on health care per capita is provided by the Government (70 per cent).

Jamaica spends a paltry US$304.60 per capita on healthcare, well below the world average of US$1,041.90. The Jamaican Government spends 57 per cent of this amount.

This per-capita spending on health care is woefully inadequate and is one of the reasons why we have an ailing health sector. The Jamaican Government, under the constraints of austerity, has little room to manoeuvre with increased budgetary allocations for health.

If we are to get to at least the world average for per-capita spending, and a well-financed health-care sector, this gap must be bridged by the private sector. However, the cost of private care in Jamaica does not correlate with our GDP per capita. It is too expensive to seek private health care for the majority of Jamaicans, not only the poor, but the middle class as well. This barrier to private care is why we have overcrowding of the hospitals and clinics.

Health care is a consumable, like any other product for sale. Everyone will at some point require health care. This comes with a price tag. Even staying healthy is now a multibillion-dollar industry in the form of the wellness, supplements and physical fitness industries.

Those who provide these services have to invest time, training and dollars. There must be some return on these investments. For the private sector, it is profits. For the Government, it is a healthy productive workforce that votes for them. A productive workforce generates revenue for the Government via tax dollars. The economy cannot grow without a healthy workforce so the survival of the nation depends on the health of the people.

In a government-controlled system, the government owns all the services - diagnostic and therapeutic. Employees such as doctors, physiotherapists, lab technicians, nurses, pharmacists, etc provide the services to the patients for meagre salaries compared to those in the private sector. In addition, because of the bulk purchase of supplies and the high utilisation of diagnostic services, the cost of care is considerably lower than in the private sector.

The private sector cannot compete with the government service on cost. It, therefore, must cater to a niche market of patients who want a more individualised, quicker service that is often more technologically sophisticated.

In Jamaica, the options are free health care with long waiting times in overcrowded, short-staffed, undersupplied facilities, or prohibitively expensive private care.

A hybrid of these systems would bring proper health care into the reach of the average Jamaican. This would save the crowded public system from having to treat those who can afford to pay, but can't afford fully private care. A good, cheap and efficient hybrid would result in the purely public system being primarily a vehicle for socialist medicine, catering to the most vulnerable at no cost to them.

There are several models that can be employed to achieve this public-private partnership. The Build, Own, Operate and Transfer (BOOT) model could see private facilities getting special concessions from the Government for a period, after which ownership is transferred to the Government. This has worked for our highways and should be a practical solution for hospitals.

Currently, some facilities are granted waivers in return for treating patients from government facilities free of charge. This could be extended and these facilities could be paid a low fee per patient treated, which would be augmented by the large volume of patients referred from the public institutions. This would save the Ministry of Health (MOH) from significant capital outlay and service contracts for equipment. It would also be a stimulus for the economy, as health dollars would be contributing to growth of an industry rather than sustaining an inefficient system.

Many patients using public hospitals would rather pay for more personalised care at a private ward. The University Hospital has capitalised on this need for years. Were public hospitals to adopt this model, it would be an added source of revenue for the MOH. The private partners would do the construction and outfitting of these private wards. The Government's contribution would be the existing magnet hospital.

This model has been shown to be profitable in other countries such as The Bahamas, The UK, Singapore and South Africa. The addition of private wards generates a surplus that can be used to subsidise care on the public wards. This is a win-win situation for all parties.

If we are serious about improving health care, we can't scratch our heads trying to figure out how to squeeze more out of US$304. We have to look at innovative ways in which to increase that amount. The current economic model of private sector-led growth must be applied to fixing health.