Editorial | Turning health investment into health outcomes

The recently released Jamaica Health Public Expenditure Review is both encouraging and sobering: though there has been significant investment made in healthcare, higher spending has not necessarily translated into better outcomes.

Despite increased spending, non-communicable diseases account for nearly 80 per cent of deaths in Jamaica. Maternal and neonatal mortality remain unacceptably high. The review also highlighted that Jamaica’s per capita health expenditure remains below that of several comparable countries.

Perhaps the review’s most telling finding is that the healthcare system remains heavily oriented towards treating illness rather than preventing it. Too many resources are being spent on expensive hospital-based care while primary healthcare and prevention require greater emphasis.

According to the World Bank-backed report, prepared at the request of the Government, by 2021/22, health spending accounted for 16 per cent of central government expenditure, one of the highest shares in the Caribbean. Government financing now covers 68 per cent of current health spending, up from less than 40 per cent in 2012, while out-of-pocket payments have fallen to 15 per cent, below the internationally accepted 20 per cent threshold.

The broader lesson is that public health systems deliver their greatest returns when they prevent disease rather than just respond to it.

Which is what the World Bank report recommends, calling for stronger primary healthcare, improved accountability, expanded workforce capacity, better use of performance management systems, more effective control of pharmaceutical costs, and earlier diagnosis and management of chronic diseases.

Health Minister Dr Christopher Tufton has welcomed the review’s findings and argued that they support the direction outlined in Vision for Health 2030 Strategic Plan.

NOT NEW

Many of the weaknesses highlighted by the review are not new. Concerns about maternal mortality, weak primary care, late diagnosis of chronic diseases, staffing shortages and accountability gaps have been raised over the years.

Dr Tufton acknowledged these gaps. “Spending per person is still below our peers …, too much of it goes to late-stage hospital care, and medicines costs have grown rapidly,” he said in his presentation to Parliament on Tuesday, adding, “… our Service Level Agreements with the Regional Health Authorities are not yet used to their full potential to hold the system accountable.”

Capital spending more than doubled between 2015/16 and 2019/20, while expenditure on maintaining and upgrading health facilities increased by 150 per cent. National Health Fund prescriptions rose from 1.5 million to 2.7 million, enrolment increased by 86 per cent, and prescription fill rates improved from 85 per cent to 92 per cent.

The Government has also expanded the healthcare workforce through additional doctors, nurses, community health aides and public health inspectors.

In June, the Ministry of Health and Wellness introduced an accountability framework across Regional Health Authorities, professional councils and public bodies. Under this framework, the entities are assessed against 18 standards in six areas: strategic planning and performance management, financial management, procurement, governance and internal controls, human resources, and digital transformation.

Patient feedback is also being sought through the Client Care Connect system.

GAPS REMAIN

Yet, the review’s concern that gaps remain after a decade of increased spending suggests that the challenge is that problems are not being identified, and solutions aren’t being implemented effectively enough to change outcomes.

Opposition Spokesperson on Health, Dr Alfred Dawes, has questioned the increased health spending.

“The budget has more than tripled, yet the World Bank review finds mothers and newborns still dying at rates that are too high, cancers and chronic diseases rising, and patients reaching hospital too late for cheaper treatment,” Dawes said.

Health spending has increased from $60.15 billion in the 2016/17 financial year to more than $200 billion allocated to the Ministry of Health and Wellness for the current financial year.

Dr Dawes is calling for a reassessment of health spending priorities, proposing greater investment in primary healthcare services, improved recruitment and retention of medical professionals, and the procurement and maintenance of equipment at public hospitals.

The overarching objective of policymakers should be to work towards measurable results, particularly in areas like maternal health, chronic disease management, and preventive care.

The lesson is that success is ultimately measured by outcomes. Health systems should be judged by healthier mothers, healthier children, earlier diagnosis of disease, fewer preventable hospitalisations and longer lives.

The Jamaica Health Public Expenditure Review provides a valuable roadmap. The Government deserves credit for commissioning it and accepting its findings, but it is critical that these recommendations are actioned with urgency.

The measure of Jamaica’s health investment will be whether investment in healthcare produces better outcomes for the people.

On that score, the review makes clear that significant work remains.