The measure of health-care success

If the success of the fee-less health-care system is measured by its ability to win votes, it is an undisputed winner. No doubt, it helped the current administration to squeeze out a marginal win in the 2007 general election. However, if it is measured by the promised and badly needed increased efficiency in public health-care delivery, that's a different story entirely.

After three articles in The Gleaner criticising the policy of scrapping user fees (March 31, 2008,November 30, 2009, and March 28, 2011), I had given up voicing my opposition. But, having very recently witnessed, first-hand, the threat to the life of a friend as he was left to wait on help in the relatively empty Casualty Department of one of our major rural public hospitals while he haemorrhaged profusely, I am making yet another bid to do my bit in petitioning the authorities to rescind this impractical policy.

Fee-less government health care (for people of all ages) was initiated on April 1, 2008. This administration also said that it would, concurrently, review, upgrade, improve, finance and expand the existing public-health facilities. It also promised to increase the availability of medical personnel in short supply and to explore telemedicine technologies and health tourism.

Significant contribution

It was a brilliant political tactic because, although accessing all government health facilities always attracted user fees, only very few people paid. Consequently, it certainly seemed that abolishing user fees would only result in giving up a measly income. However, the brains behind this political manoeuvre did not seem to realise that the 'measly' income contributed about 11 per cent to public health care and represented a whopping $1.7 billion annually.

Amid sporadic petitions (especially from medical personnel and organisations) to discontinue the no-user-fee policy, this administration sought to retroactively justify the rationale for instituting the system with a reference to a United Nations document, the Report on the World Social Situation 2010: "Most key players in the health arena now recognise that user fees constitute asignificant barrier to access to health services ... . Removing user fees has proved tobe an effective strategy for increasing access to health care."

Interestingly, an extremely relevant portion of the very next paragraph was never quoted: "At thesame time, removing fees will entail additional resource requirements. It is therefore importantto ensure that additional funding is available for countries that want to remove fees. To supportthe permanent removal of user fees and to ensure that the poor benefit from such actions, feeremoval needs to be part of a broader package of reforms that includes increased budgets tooffset lost fee revenue."

Underfunctioning system

Inordinately long waiting times at clinics, for medical intervention, emergency rooms and pharmacies; lack of adequate staff complement, equipment, reagents, instruments, linen and basic necessities; malfunctioning equipment and a lack of space all testify to an underfunctioning health-care system.

But, don't take my word for it. Take note of a recent Word 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 health care 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 health care in Jamaica."

Given our dire financial problems, the underfunctioning fee-less health-care system and consequential suffering and unnecessary deaths, I see no reason why this administration does not allow patients (or their relatives) to pay whatever they can when accessing the system. We can't keep putting politically motivated decisions before the well-being of our citizens.

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