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The fight against rising health costs

Published:Wednesday | November 23, 2016 | 12:00 AM
Christopher Zacca

Many lives have been saved because of access to subsidised medicines to treat diseases such as cancer, diabetes, hypertension and heart ailments. Over a decade, the National Health Fund (NHF) has spent more than $20 billion providing subsidy for prescription medications.

Established in 2003, the NHF is designed to finance projects that support primary health care, with emphasis on health promotion and illness prevention. Many Jamaicans recognise the entity as being responsible for the procurement, warehousing and distribution of pharmaceuticals to public health facilities. It spent $8 billion to acquire pharmaceuticals and sundry items in 2015. Prescription drugs are subsidised to the tune of $5 billion annually.

Additionally, the NHF has funded a range of health projects, including post-hurricane rehabilitation repairs, as well as training personnel and equipping health-care facilities.

In the face of such enormous costs and the ongoing struggle to contain pharmaceuticals, the NHF is in search of funding partners, Fourth Floor participants learnt when the panel sat down to explore approaches to funding health care.




Hailed as a successful health financing instrument, the NHF gets 23 per cent of its funds from the sin tax on tobacco and alcohol, the rest comes from the special consumption tax on imports and the National Insurance Scheme. Ironically, a successful anti-smoking campaign has reduced demand for cigarettes and will directly impact the level of funds flowing to the NHF.

Actuarial studies predict rising demand for health-care services due to the fact that people are living longer and Jamaica's population could double in 15 years.

Could a tax on sugary drinks put the NHT on a more sustainable footing? Not so fast, cautioned Howard Mitchell, who heads the Wellness and Healthy Lifestyle Foundation.

While he is committed to placing the issue of sugar before the political directorate, he favours a gentle approach which involves developing a robust, healthy culture. "The population must be weaned into a health culture which reduces the need to go searching for more sin taxes," said Mitchell.

Christopher Zacca, chairman of the NHF, agreed that everything should be on the table when funding is being examined, although he refused to be drawn into specifics. "If you are going to tax things that are unhealthy, like cigarettes, it should not go into central budget at this point, it should be dedicated to the health sector," he added.

The NHF provides subsidised drugs to treat up to 16 chronic illnesses. Even with the subsidy, though, a 65-year-old pensioner who suffers from heart disease, hypertension and prostate problems will likely have to fork out $20,000 for medicine each month.


Affordability an issue


Affordability is still an issue for many persons and medical conditions go untreated, with the result that patients eventually end up in the emergency room. The financial toll and the ripple effect of various illnesses can significantly impact a community's economic well-being.

"We are always working on cost efficiency," said Zacca. To illustrate that point, he reported that certain cancer treatment drugs were now being sourced through Pan American Health Organisation.

The NHF distributes drugs through its Drug Serve pharmacies, which are tightly stretched because of high demand from an ageing population together with a rise in patients' expectations. Zacca acknowledged that more has to be done to meet this rising demand in a more efficient manner.

"We are not going to invest billions in building government pharmacies. We have a plan to deliver prescriptions for the public sector through a partnership with private pharmacies," he explained.

The NHF is also seeking to improve its Jamaica Drug for the Elderly Programme (JADEP), which provides subsidised medications for 10 specific illnesses to beneficiaries 60 years and older. There are currently 282,000 persons enrolled under JADEP, which is in its 10th year of operation. Zacca wants more private pharmacies to accept that card.

Better health care is the mantra of Zacca and the NHF board. Right now, they are looking at ways to improve the delivery of health care. The thinking is that focus should be placed on primary health care and diagnostic services such as X-ray, CAT scan, MRI and blood tests.