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Please Honourable Health Minister (Part 1)

Published:Sunday | November 22, 2015 | 12:00 AM

The new minister of health has at least one great advantage over his predecessor - he has witnessed the pitfalls and areas of concern within the ministry. He has stated that he plans to make changes and singled out accountability. But, I'm concerned that the same flawed system will remain in place. After all, one reason for our health-care problems in the no-user-fee policy.

In 2007, when the Jamaica Labour Party (JLP) launched its manifesto in which it promised "Unrestricted, universal access to health care", my antennae went up. And when I read section 27.5, "Free Public Health Care: Abolish user charges at all health facilities, including public hospitals", I was fearful of what would follow.

The JLP promised to (concomitantly) review, upgrade, improve, finance and expand the existing public health facilities. They also promised to increase the availability of medical personnel in short supply and to explore telemedicine technologies and health tourism. I was left wondering how all that would be achieved without income from fees and, as expected, that was all political talk.




Some bright spark decided that since only a few patients were paying the user fees, eliminating them was no 'biggie'. But, the genius political strategist never took the time to ascertain how much those few were contributing to the system. It turns out that those who paid were contributing about 11 per cent to the health-care coffers, a whopping $1.7 billion!

The no-user-fee health-care system (for people of all ages) was initiated on April 1, 2008. Crowds seeking freeness descended on our understaffed, ill-equipped health-care facilities. Over time, when it groaned and began buckling under the strain, the health minister of the day attempted to justify the already-failing healthcare system by quoting 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 health care".

But the minister of the day conveniently forgot to mention the very next paragraph which stated: "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". Jamaica had no increased budget to offset anything.




And then there followed this World Bank report, Realising Rights through Social Guarantees: The Case of Jamaica, with its comments on 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." That was certainly a sublime understatement.

The main problem in our health-care system is a woeful lack of funding. We need to rescind the failed 'no-user-fee policy'. Individuals have opined that reinstating user fees would prove challenging because we would need to do assessments to ascertain who could afford to pay. They proffer that it would entail hiring a lot of people and/or acquiring software to regulate payments.

However, in my opinion, all that needs to be done is to resume generating bills and allow patients to pay what they can. This is what happened before the user fees were discontinued.

Please, Honourable Health Minister, make the bold move and allow patients to pay what they can afford. It will save lives. From the premature neonates to the helpless elderly, our people deserve much better than they are being given now.

- Garth A. Rattray is a medical doctor with a family practice. Email feedback to and