Health sector on life support

Dr. Shane Alexis, Guest Columnist

The Medical Association of Jamaica (MAJ) has consistently placed on public record our deep concern on the standard of care being delivered in the public system under the no-user-fee policy. Our health sector is in crisis.

At other important times in our country's history, the MAJ has also shared its opinion on other health programmes and policies. The collective experience and expertise of the MAJ offers a valuable perspective on the current state of health care in Jamaica.

In 2011, the MAJ made an extensive presentation to a parliamentary committee which was, we understood, to review the no-user-fee policy with the possibility of making changes. To date, there has been no significant change to that policy. All government policies must be considered on their merit, and constructively criticised, so that the best outcome for all citizens may be achieved.

We had advised the Govern-ment at various levels in 2008 of inherent weaknesses of the health-care system which still exist. Our concerns are, but are not limited to: the severe underfunding of the health budget, with its negative implications on labour, capital investment, and best practices in patient care, and the sharp increases in patient load at health facilities without the adequate and concurrent increases in medical and support staff.

Additionally, this would have a direct negative impact on patients of even longer waiting times for elective surgery, pathology reports, cancer treatments, and so on. This often results in increased risks of complications.

Regrettably, much of the brunt of the public's complaints, criticisms and even allegations of bad practice have been inappropriately levelled against the employees of the sector, including doctors. It is true that patients experience long waits for critical services such as dialysis. However, before the accusation is made that doctors are to blame, let's examine the facts. Many requests have been made by medical staff for additional basic equipment to provide services in both health centres and hospitals. The decisions regarding budgetary allocations and policies are made by the Ministry of Health.

Furthermore, some members of the public believe that the public health sector unfairly provides an opportunity for physicians to capitalise through private ventures, i.e., facilities for private care. But in situations where the Government is not adequately providing a service, shouldn't there be an alternative? Or should patients be left to suffer?

Consultant physicians in public hospitals have the privilege of providing private care within the institution as a negotiated benefit of their employment, the terms of which are well documented. All patients may avail themselves of the relevant information at the public institution they visit.

Disciplinary sanctions

Let me, however, make it clear that in the event that a patient believes that a doctor has been unethical or unprofessional, it is the right of the patient to make a written complaint against that doctor to the Medical Council of Jamaica. The Medical Council is the legally recognised body for the investigation of complaints and, where applicable, will impose disciplinary sanctions. All doctors take an oath to uphold professional and ethical standards (Oath of Hippocrates) and, while non-binding, are expected to adhere to it.

The MAJ has also offered several recommendations to improve the quality of health care in the public sector, the first and perhaps most important of which is to have meaningful consultations with stakeholders in the health sector. These consultations must lead to actions in a reasonable time frame. Our patients and their relatives have trusted our advice for almost 50 years, and so should our Government.

For health care to be of a high standard, it must be adequately and sustainably funded. Jamaica's percentage of gross domestic product (GDP) spent on health care is approximately four per cent. The international recommendation is 10 per cent. We must increase the allocation to health care now.

Two reasons for this are manifest:

1) The moral, social and financial cost of health complications to patients and their families (waiting times, lack of resources, etc.) is likely to exceed the short-term burden to the national Budget.

2) The cost of several inputs for health-care delivery, such as drugs, diagnostic machines and even some utilities, are priced in foreign currency. With all other factors remaining the same, and only considering potential movements in the Jamaican dollar exchange rate, it may cost more for the same level of health services without improvements. It is a worthwhile suggestion to consider an affordable 'basket' of agreed health services accessible to all citizens. This may be expanded over time.

On October 16, 2013, the MAJ, in collaboration with private-sector partners, hosted a public forum on the 'Sustainable Financing of the Public Health Sector in Jamaica'. Trade unions, human-rights groups, politicians, and government agency officials, among others, were represented. Several possible approaches to funding health care were made by presenters who were independent of the MAJ.

Some of the solutions suggested were, but are not limited to: tax incentives for 'healthy' practices by companies and individuals (potential reduction in the cost of care for the country), the establishment of a National Health Insurance Scheme, financial incentives for investors in health tourism, with the potential government profits to be invested in the local health-care system. In addition, entities whose products are high in saturated fats and sugars, or are generally associated (based on scientific evidence) with negative health outcomes (obesity, hypertension, diabetes, etc.), should contribute financially to the overall cost of health care.

We continue to await a response to the recommendations made at that forum, as this has direct bearing on the viability of our public health sector.

Difficult decisions

Doctors are aware that under the current difficult economic climate, choices have to be made. We remain ready to assist those who must make the difficult decisions that will affect all of us. There are still creative options and opportunities to fund our health-care system.

The MAJ recognises the hard work, significant contributions, and positive achievements made by the Jamaican Government since our Independence. In many health indices, we have an enviable international record.

Urgent health-care reform, and a clear medium-term plan for the development of primary, secondary and tertiary care, are imperative. A robust and efficient public-private partnership policy for health could encourage investors locally, and in the diaspora, to relieve Government of some of the financial burden of capital investment in health services. The Government could then focus more on policies, standards and the effective implementation of programmes that protect the health and well-being of Jamaicans.

Dr Shane Alexis is president of the Medical Association of Jamaica. Email feedback to columns@gleanerjm.com.