Sur­vey reveals Ja­maicans still want rich to stand the cost for health care; new tax­a­tion for the sec­tor

Jamaica Gleaner - - FRONT PAGE - Ed­mond Camp­bell and Anas­ta­sia Cun­ning­ham Staff Re­porters

AL­THOUGH THE ma­jor­ity of Ja­maicans be­lieve that the health-care sys­tem has taken a sig­nif­i­cant plunge for the worse in the eight years since the Bruce Gold­ing ad­min­is­tra­tion re­moved user fees in the pub­lic hos­pi­tals, they ad­mit that they would strongly ob­ject to a widescale rein­tro­duc­tion. In­stead, they be­lieve that to al­le­vi­ate some of the stress be­ing faced by an over­bur­dened, un­der­funded pub­lic-health sys­tem, the Gov­ern­ment should in­tro­duce a pay­ment scheme that would only ex­empt poor Ja­maicans, as well as im­ple­ment tax­a­tion for the sec­tor. This was re­vealed in a re­cently con­ducted Gleaner-com­mis­sioned sur­vey of the health sec­tor, con­ducted by Johnson Sur­vey Re­search Ltd. Polling 1,200 men and women be­tween ages 18 and 65 and over dur­ing the month of Septem­ber, the study sought to gauge Ja­maicans’ view of the health-care sys­tem and the im­prove­ments needed, in­clud­ing the con­tro­ver­sial no-user-fee pol­icy. Ever since the Gov­ern­ment abol­ished it in 2008, it has been a con­tentious is­sue, with calls from all quar­ters for the Gov­ern­ment to come up with a more sus­tain­able solution. The main com­plaint has been that there were in­ad­e­quate re­sources to match the in­crease in per­sons now mak­ing use of the free ser­vices, which has led to a rapid de­te­ri­o­ra­tion of pub­lic health care. In the sur­vey, 31 per cent said health care has got worse, com­pared to the mere three per cent who thought it had got bet­ter. Twenty-two per cent said they saw no dif­fer­ence since the no-user-fee pol­icy came into ef­fect, while 16 per cent said they did not know. At the same time, 49 per cent of the par­tic­i­pants do not want the Gov­ern­ment to rein­tro­duce user fees, while 41 per cent be­lieve that they should. In or­der to deal with the short­fall in the un­der-re­sourced sec­tor, 18 per cent sup­port some form of in­creased tax­a­tion (an­other two per cent want new ones), while 12 per cent think the Gov­ern­ment should charge those who can af­ford to pay and only al­low poor Ja­maicans to ac­cess the ser­vices free of cost. Oth­ers felt it was a mat­ter for the Gov­ern­ment to work out. At least one med­i­cal or­gan­i­sa­tion is in sup­port of some form of pay­ment scheme in the pub­lic health sec­tor. The Med­i­cal As­so­ci­a­tion of Ja­maica (MAJ) is call­ing on the Gov­ern­ment to re­tain the no-user-fee pol­icy for only the vul­ner­a­ble and in­tro­duce some form of national health in­sur­ance scheme – a pol­icy that the Gov­ern­ment now has un­der re­view. “What we say is that even if the an­swer is not rein­tro­duc­ing user fees right across the board, then the Gov­ern­ment should at least look at re­tain­ing a nouser-fee pol­icy for the vul­ner­a­ble in so­ci­ety,”

MAJ’s pres­i­dent, Dr Myr­ton Smith, told The Sun­day Gleaner, echo­ing sen­ti­ments cap­tured in a sur­vey of health­care pro­fes­sion­als in 2013 by the Caribbean Pol­icy Re­search In­sti­tute (CAPRI), whose then co-ex­ec­u­tive di­rec­tor, Dr Christo­pher Tufton, is now the health min­is­ter.

In his call for the national health in­sur­ance scheme, he said, “Health care is ex­tremely ex­pen­sive all across the world, and as a pop­u­la­tion we are un­der­in­sured. It’s prob­a­bly less than 30 per cent of the pop­u­la­tion that has pri­vate health in­sur­ance, and that now cre­ates a prob­lem in terms of fi­nanc­ing and af­ford­ing health care.”

Pub­lic-sec­tor user fees were tem­po­rar­ily abol­ished dur­ing the 1970s but re­in­stated in 1984.

With the dec­la­ra­tion that “there must be univer­sal and free school­ing and health care as the be­gin­ning of jus­tice for the poor­est coun­tries of the world”, at the 2005 World Health As­sem­bly, 189 coun­tries pledged to move away from user fees in pub­lic health-care fa­cil­i­ties and schools. It was also at that as­sem­bly that the G8 group of wealthy na­tions agreed to as­sist coun­tries that wanted to stop im­pos­ing user fees.

In 2007, the Ja­maican Gov­ern­ment in­tro­duced no user fees for chil­dren un­der 12 at any pub­lic health fa­cil­ity. In con­tin­u­ing

its commitment to univer­sal ac­cess to health care, a year later user fee was re­moved for ser­vices at pub­lic hos­pi­tals for all per­sons, ex­cept the Univer­sity Hos­pi­tal of the West In­dies.


In the sur­vey, when the poll­ster drilled to de­ter­mine the ba­sis for the views ex­pressed, they found that among those who say the sys­tem has wors­ened, the largest chunk (48 per cent) were con­cerned with the gen­eral qual­ity of the ser­vice be­ing de­liv­ered, while 39 per cent com­plained of long waits at the in­sti­tu­tions – a re­cur­ring re­sponse from the par­tic­i­pants.

Seven­teen per cent high­lighted in­ad­e­quacy in the pub­lic hos­pi­tals of the drugs pa­tients are pre­scribed, while a sim­i­lar pro­por­tion (16 per cent) com­plained of in­abil­ity to re­pair equip­ment – two is­sues that go to the cen­tre of the economics of free health care.

At the time of the re­moval of user fees, it is es­ti­mated that the Gov­ern­ment was giv­ing up around J$2 bil­lion a year in ac­tual in­come and sev­eral bil­lions more in un­paid bills. This for­gone cash, plus more to off­set higher costs from an ex­pected growth in pa­tient vis­its, was to be cov­ered by in­creased cen­tral gov­ern­ment al­lo­ca­tions.

But gov­ern­ment spend­ing on health care, al­though it rose ini­tially, has not kept pace with what health ex­perts say has been an ex­po­nen­tial growth in de­mand for ser­vices. In fact, more re­cently, it has de­clined in

real terms in the face of fis­cal con­straints. For in­stance, the J$53 bil­lion bud­get for the cur­rent fis­cal year, of around 3.3 per cent of gross do­mes­tic prod­uct (GDP), is roughly equiv­a­lent to what was spent in 2015-16 when in­fla­tion is taken into ac­count.

Al­though less money, in real terms, is pay­ing for the treat­ment of more pa­tients, it is this rise in num­bers, and the fact they are not called on to go into their pock­et­books, that un­der­pin the sup­port of those who say the sys­tem has im­proved. Fifty-six per cent of those who feel the sys­tem has im­proved give as their ev­i­dence the fact that more peo­ple are be­ing treated; for 39 per cent it is the fact that ser­vice is not de­pen­dent on abil­ity to pay.

Per­cep­tions on whether the pub­lic health sys­tem has ei­ther im­proved or de­te­ri­o­rated are split along gen­der lines, with 29 per cent of men be­liev­ing the for­mer and 44 per cent the lat­ter.

The MAJ’s Smith is not sur­prised that more women say the sys­tem has wors­ened, as he said they were more likely to come in contact with it, both as users and fa­cil­i­ta­tors of chil­dren.

On the mat­ter of the rein­tro­duc­tion of user fees, gen­der and age ap­pear to play a more sig­nif­i­cant role in de­ter­min­ing po­si­tions. Just over half (51 per cent) of men say no, against 39 per cent who would coun­te­nance it. Women are more evenly split, with 42 per cent in sup­port and 48 per cent against.

The great­est sup­port (48 per cent) for user fee is the 55-64 age group, while the strong­est op­po­si­tion is among young peo­ple: 58 per cent among those be­tween 18 and 24; 52 per cent for those in the 25-34 co­hort, and 46 per cent and 48 per cent, re­spec­tively, in the 35-44 and 45-54 age groups. Sur­pris­ingly, for older per­sons likely to be head­ing into retirement, op­po­si­tion to pay­ing ta­pers off sub­stan­tially: 36 per cent among those age 55 to 64, and 33 per cent among those 65 or older.

Do you think the Gov­ern­ment should start charg­ing user fees again at the pub­lic hos­pi­tals?

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