The indignity of being poor and sick in Jamaica
Part 2 — More of the same won’t do
Lorna’s daughter remains in hospital. she is visited by multiple doctors daily as Lorna continues to buy the medication, special gauze, and other essential medical amenities critical to her healing. These are expensive duties for Lorna.
There is no doubt that Jamaica has some of the most competent and professional doctors and nurses worldwide. A few years ago, our health minister, Dr Christopher Tufton, lamented that he could not stop our nurses’ exodus from our shores. After all, our nurses are globally sought after and leave Jamaica annually for better wages and working conditions.
Our public health sector urgently needs resources to not only equip our health facilities but to adequately pay our doctors, nurses, and other critical medical personnel for their work.
The Ministry of Health and Wellness is responsible for ensuring the provision of an adequate, effective, and efficient health service for the population of Jamaica to the Government’s network of 23 hospitals and over 336 health centres and specialised institutions islandwide.
Its vision is: ‘Healthy People, Healthy Environment’. It envisages a client-centred health system that guarantees access to quality health care for everyone in our population at reasonable costs, and takes into account the needs of the vulnerable among us. Furthermore, it seeks to provide information and educate the populace to facilitate individuals taking responsibility for their health, making informed decisions, and adopting healthy lifestyle habits. All this is within a clean, healthy environment where families and communities actively participate and are integrated into the health system. (Estimates of Expenditure 2023-2024)
For this financial year, the health ministry received recurrent and capital budgets of $115.8 billion (US$751 million) and $6.428 billion (US$41.74 million), respectively. Combined gives a per capita allocation of $43,652 (US$283.46) for health expenditure for each Jamaican annually.
A cursory glance at some countries with leading public health-care systems spends approximately 10 per cent of their gross domestic product (GDP) on funding them. According to 2019 World Bank data, their government per capita spending amount to the following: USA, US$10,921; Denmark, US$6,003; Germany. US$5,440; Canada, US$5,048; and the UK, US$4,312.
In our region, other examples of the government per capita spending for 2019 on public health care include: Trinidad and Tobago, US$1,167; Barbados, US$1,143; Cuba, US$1,032; Dominican Republic, US$491; and Jamaica, US$347. (www.worldbank.org)
Two of the ministry’s objectives are to:
(1) advocate for an average annual increase of 6.5 per cent of the budget allocated to the health ministry and its agencies; and
(2) attain the World Health Organization’s (WHO) benchmark of 6 per cent of GDP for government expenditure on health by 2030.
But how will we increase our budget for the public health sector if we do not prioritise growing our economy to provide the resources? What is the short-term solution?
In 2022 Jamaica received 3.3 million visitors. Unlike traditional tourism, which gives revenues of US$113 per person per day spent by stopover visitors, medical tourism has the potential to generate higher earnings of approximately US$1,300 per medical tourist per day. Today, the global medical tourism market accounted for US$104.68 billion in 2019 and is projected to reach $273.72 billion by 2027. Now, more than ever, Jamaica must develop a medical tourism sector to capitalise on this growing global trend.
We are ideally suited to become a leader in medical tourism. However, we lack proactive speed in government policy and an intense focus to succeed in this industry. The mindset required to take advantage of this opportunity must begin with removing all Customs duties on medical equipment. With ongoing rapid advances in medical technology, diagnostic equipment becomes obsolete very fast. Therefore, imposing Customs duties on medical equipment is counterproductive for our overall health-care sector.
The Government would get more from the income tax charged on the doctors versus the one-off duty charge for the importation of first-generation, advanced technological equipment needed to create the necessary facilities. This would naturally develop into public/private partnerships and redound to the best interest of Jamaica’s overall health care system, as it would also give more Jamaicans access to modern equipment at lower costs. In addition, incentivising doctors to build their capacity could lessen the pressure on the public sector.
What’s more, if we developed this industry, it would ensure that our best and brightest medical minds are kept in Jamaica and not leave the country based on the frustrating working conditions.
Our tax structure has remained the same for years. We need to rebalance how we collect our taxes to reflect our current realities. Don’t get me wrong, I am not advocating that we de-incentivise individuals already paying their fair share of taxes. However, in 2015, as finance minister, Peter Phillips reduced the tax rate allowing us to collect more in taxes because of better compliance. No doubt, a rising tide lifts all boats; therefore, if we make it better for the most vulnerable among us, we will all live a better life in Jamaica.
Therefore, I propose revisiting and prioritising some areas of tax collection for specific purposes. For example, hotels which are mostly foreign-owned get a windfall every time there is a devaluation. It’s time that hotels fund the Jamaica Tourist Board (JTB) directly to take the burden off the average taxpayer. The direct taxes collected from us taxpayers to fund the JTB could be redirected to the Ministry of Health and Wellness, in addition to giving adequate health insurance to tourist workers.
Quantum leaps are not achieved by pursuing more of the same. Instead, we must decide, as a nation, what is vital to our people. We have been following the same roads the same way for far too long, achieving only mediocre results in exports, education, agriculture, public infrastructure, and so on. We need to stop and make some radical changes to how we have been governing.
Giving our people a good education and essential health-care services are two critical areas that need immediate attention to transform our country.