Generally in the pink
DOCTORS and the Opposition spokesman on health have a few disappointments. But generally they agree that the Government’s National Health Fund, scheduled to start next month, is a good programme that will significantly cut the cost of medical care to Jamaicans.
“It really is not nearly as much as I would like it to be,” Medical Association of Jamaica (MAJ) president, Dr Errol Daley, said of the fund on which the administration intends to spend $2.5 billion annually. “But it is a step in the right direction.”
Since 1997, the Government had been trying to perfect and implement the National Health Fund (NHF), a revision of its National Health Insurance Policy (NHIP).
At the time, the MAJ, being headed then by Dr Winston Davidson, opposed the policy on the basis that it required taxpayers to pay into a Standard Benefit Package to gain access to hospitalisation, in-patient care, and laboratory and diagnostic procedures.
The 1997 plan, the MAJ said, was “conceptually flawed” as it sought to tax people under the “guise” that it would solve some of the nation’s health problems even as it ignored the key element of disease prevention.
“What has been in the pipeline for a long time is an attempt to create a national health insurance programme,” explained Dr Daley.
But when the Government tried to introduce that programme three or four years ago, the health sector rejected it “because we knew it was not affordable” Dr Daley said.
“We pointed that out… and that there is no point in making a show of something if we really can’t afford it,” Dr Daley told the Sunday Observer.
The new fund, which was recently announced by Health Minister John Junor, will be funded from a “sin tax” on tobacco and alcohol, as well as from the National Insurance Scheme. The Cabinet is expected to sign off on this new financing proposal at its weekly meeting tomorrow.
Under the fund, Jamaicans will be able to access treatment for 14 chronic illnesses. They include heart disease, cardio-vascular diseases, such as stroke, hypertension and diabetes that were, in 1991 for example, the leading causes of death in the island.
In addition, the fund, which will be operated as a statutory body, will provide funding for medication for persons with:
* arthritis and asthma;
* breast and prostate cancer;
* epilepsy and major depression;
* psychosis and rheumatic fever; and
* high cholesterol.
Persons who wish to benefit from the programme will, starting next month, need only register with the Electoral Office of Jamaica (EOJ).
Rosemarie Lee, the health ministry’s public relations officer, said beneficiaries of the programme will need to complete an application form that will be available at health centres islandwide. The form will require their personal information and a doctor’s signature, verifying that they suffer from one or more of the chronic diseases.
Once that is done, Lee said the form is to be submitted to the EOJ along with the applicant’s identification and tax registration number (TRN) for processing before they become beneficiaries.
Persons under 18 without a TRN need not worry.
“The fund is making arrangements with the Tax Registration Centre to have TRNs issued to persons under 18 years old for the purpose of registering with the National Health Fund,” Lee said.
The registration process is one way in which the new fund differs from the 1997 policy that recommended legislation to force employers and employees to pay premiums, while the Government would pay for the indigent.
While Daley and Davidson admit that the new plan is not as comprehensive as they would like, they feel it is a significant improvement on the 1997 plan that was tabled in Parliament.
“We have to walk before we run, and the walking is not perfect. But it is the beginning,” argued Dr Daley. “The National Health Fund is one way of attempting to ease some of the cost of some chronic diseases. …We want to see more happen, but until it becomes affordable, both for the Government and the people, I don’t see how we are going to be able to.”
Dr Davidson, who now heads the Public Health Doctors’ Association, feels that the programme will require careful monitoring to ensure that people really benefit.
“We have to see to it that all elements of the concept are implemented in a way that it will show transparency and (reflect) continuous consultation,” he said. “Because I don’t expect that the implementation will be 100 per cent in terms of its quality of service or other aspects of it.”
Added Dr Davidson: “One has to monitor the provision also because it is going to be necessary to do proper evaluation as to what has transpired. Hopefully, the monitoring will not be restricted only to health personnel within the ministry but a broad-based group involving those who work outside the system and who can look at it objectively to see that it is working, not only for a small group, but for the nation as a whole.”
Dr Davidson appeared particularly pleased with the health fund’s focus on dealing first with the chronic illnesses.
“The NHF is by no means a comprehensive health fund, in that it cannot cover all the scope of chronic diseases that we have, but it is a start,” he said.
“That is one of the strengths of the conceptual framework. You have to start in a way that makes the beginning viable from a health-economic standpoint and you build on that viability, and you don’t bring in fly-by-night schemes, or schemes that do not accord with our health organisational structure, our culture,” he added.
Dr Davidson said the fund was made even more appealing because of its provision for disease prevention and the promotion of healthy living, a point that would resonate with Junor who, for years, has argued that prevention is a key factor in health care.
“This is definitely more in keeping with not only the principles of prevention, but also in keeping with building a health service (and) creating access especially for those in the most vulnerable age groups,” Davidson said.
“The basic morbidity pattern of our health services are chronic illnesses,” he argued. “These illnesses are especially in the elderly, and so the fund, which has built into it a very strong proponent of prevention and health promotion, healthy lifestyle modification, is in keeping with the philosophy of the profession over the years.”
A portion of the fund will be dedicated to infrastructure and other development projects in the public sector, including educational and primary care activities that promote healthy lifestyles, protection and prevention.
In addition, the Drugs for the Elderly Fund, that caters only to persons over 60, will be incorporated into the NHF when it becomes operational next month.
According to the health ministry’s Lee, the limitation on medication, offered at reduced cost under the Drugs for the Elderly Fund, will no longer apply.
“Right now, those beneficiaries stand to receive an additional number of pharmaceutical items,” Lee said.
The programme, according to Government senator, Floyd Morris, should be extended to beneficiaries of the administration’s Programme of Advancement Through Health and Education (PATH).
Morris had told a recent education symposium in Negril, that he would negotiate with the health ministry to provide PATH beneficiaries with access to the more than 70 drug types to be available under the fund.
PATH was set up last year to combine the benefits that were usually offered under the Food Stamp, Old Age and Incapacity and Outdoor Relief programmes.
Meanwhile, Dr Ken Baugh, the Opposition spokesman on health, said the Jamaica Labour Party welcomes the fund. However, he described it as a poor reflection of its predecessor.
“It is a welcomed facility,” Dr Baugh told the Sunday Observer. “But it is a very small step in the right direction, in that they are replacing a facility that was previously available on a larger scale.
“Up until about four years ago, the provisions for drugs and medical supplies were slashed by some 90 odd per cent in some hospitals. In others it was 50 per cent and that was only the beginning,” he said.
Added Dr Baugh: “Right now it is very painful for somebody to be treated in a public hospital because, whereas before it was free or with nominal charges, now it is exceedingly expensive for our people at their level of earnings.”
He said that the fees now being charged by public hospitals were prohibitive.
“The National Health Fund is a relief,” he said, “but it doesn’t go far enough.”