The fight against ris­ing health costs

Jamaica Gleaner - - SPORTS -

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.

SUC­CESS­FUL

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.

Christo­pher Zacca

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