Access to health care – a double-edged evil

by Fitz T Jones 29.OCT.10

In terms of public perception, access to healthcare is a double-edged evil. And this perception is fueled by a generally uninformed or deceptive few. Many who speak can provide alternatives to the concepts they oppose or seek to expose. Our government promotes universal access to healthcare services, but can we continue to culture the notion that quality public healthcare services must continue to be ‘free’? While society continues to look for ways to get more healthcare for less, policy makers must strive to make the system more effective and efficient.{{more}} There are those who see the cost of running our healthcare system as too high; mostly a government view. On the other hand, there is the conviction that the quality of healthcare provision is declining; clients’ perception promoted by some irresponsible individuals and institutions. But these are two sides of the same coin, and solutions must be found.

We need to agree that there is a fundamental tendency for costs to rise. The cost of inputs increases with time as providers seek more specialization and more high-tech equipment and instruments. Further, the public expects some levels of specialization and modern technology as available in more advanced economies. Then the laws of economics suggest a trade-off; either clients consume less healthcare services or the budget share to health services increase in order to at least maintain the ‘status quo’.

The failure of our healthcare system to respond to some of its immediate needs rests on the weak political administration in the 1900’s. The introduction of the user fees in 1995 was a step in the right direction. But ‘vote-catching’ forced the implementation of a less than desired system. Elsewhere in the Caribbean, the user fees are substantially retained by the hospitals to finance some day-to-day activities. Not so in SVG. This situation was further fractured by political operators retaining the ‘powers’ of determining who should be exempted from user fees. We have been promoting allocative inefficiency in the healthcare system since 1984. But we need to refocus.

Change our mind-set

Given the current economic realities, it is difficult if not impossible for the government to increase, in any substantial manner, its budgetary allocation to healthcare services without affecting other important sectors. Public-private-partnership (PPP or 3P) provides an alternative to better guarantee universal access to care in SVG. There are just those things that the private sector proves to be more efficient at providing. Further, there is the general impression that private provision of care is better than public provision, even when the provider is the same individual. PPP creates the incentives for clients to opt out of the public sector and supplement government’s provision. It encourages private investment in the healthcare infrastructure. Public supply coupled with public finance and oversight is a system to which many countries are converging.

Change our mind-set

If healthcare must continue being financed primarily through the public sector, then government will need to grow rapidly, and taxes or other methods of financing healthcare provision must increase continually. This has been our history. And we have grown accustomed to it. But our education and our expectations should direct us to change our mind-set. We need to embrace the effort of Dr. Ambrose, NCB and NIS. This nation, in terms of healthcare, needs to salute the efforts of Dr. Ambrose. “Passing over a CAT SCAN machine to a private medical outfit to the tune of 1.4 MILLION dollars?”is clearly not a question. It is a defining statement; a statement that a responsible publication may not have printed. It is simple to recognize that the service is now available to Vincentians at home.

We, as a nation, will continue the debate as to whether such things as computerized axial tomography (CAT scans); magnetic resonance imaging (MRI) and kidney dialysis should be provided, exclusively by the government. And perhaps we will never arrive at a conclusion. But in the meantime patients will cry for diagnosis and care. Do we need to disrespect the government and private provider in their attempt to increase our access to healthcare services?

Clearly, we need to lift the debate; how else can the private sector collaborate with government to expand the range of healthcare services available to our people. Perhaps we need to discuss a new kind of management for the polyclinics. Maybe the Modern medical facility should be managed by the Kidney Restorative Foundation of SVG. The debate will serve us better if we begin to promote ideas to get government out of the direct delivery of healthcare. The more we can separate the financing from the provision, and these two from policy formulation, monitoring and evaluation, the more efficient SVG’s healthcare system would become.