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Free health fallout - Too much freeness - No-user-fee policy worsening poor service - CaPRI study

Published:Tuesday | June 11, 2013 | 12:00 AM

The quality of service in Jamaica's public hospitals has got worse since the no-user-fee policy was introduced five years ago. It is now ineffective and inefficient, with nurses and doctors displaying an apathetic attitude towards patients and their general duties.

So said the findings in a review of the system by the Caribbean Policy Research Institute (CaPRI).

Conducting the study between April 15 and May 20 across all 14 parishes, CaPRI said it was also evident that the service has not only got progressively worse but also exceedingly slow. Compounding that is the increased patient-to-health-care worker ratio and insufficient medication and medical supplies to meet the demand.

"The quality of service would be better and faster if people were paying. Doctors and nurses would have a better attitude and the hospitals would operate more efficiently," noted some of the respondents who were interviewed.

"The hospitals just cannot afford the luxury of free health care and the Government can't afford to foot the bill alone. It only results in an abuse of the system and overwork the health-care workers. When it is free, doctors and nurses display a poor attitude."

Seeking to investigate the effect of the no-user-fee policy on health services in Jamaica and to explore the scope for returning to a fee-paying system in the future, the study noted that several persons were calling for the reintroduction of user fees on the grounds that free health care was not sustainable. Both health-care workers and patients were of the view that 'those who can pay, should'.

"It needs cash to care and this will help to greatly improve the system. People should contribute to their own health care, as it's very costly," those surveyed stated.

CaPRI has recommended that if the policy is to be maintained, it must be twinned with a package of reforms that address longer term health-systems issues, in particular, adequate financial resources, health worker availability and performance and drug supply chain management.

"It is worth studying the impact that the policy has had on the overall 'health of the nation' and whether or not there has been an increase in preventative health care," CaPRI concluded.

As part of its commitment to universal access to health care, in 2008 the Bruce Golding-led administration removed user fees for services at public hospitals, except the University Hospital of the West Indies. This was a significant departure from a policy of user fee reintroduced in 1984.

The Government is hosting a series of public consultations during which members of the public are allowed to propose ideas to remedy the woes in the country's health-care system.

The CaPRI study was carried out with the aid of grants from the International Development Research Centre in Ottawa, Canada, The Gleaner Company Limited and the National Health Fund.

anastasia.cunningham @gleanerjm.com