Make the health sector more efficient

The country faces enormous challenges and must make some difficult decisions. The Government must cut expenditure and make the public sector more efficient. Here are some recommendations to reduce expenditure in the health sector:

Cut administrative costs

Several years ago, the regional authorities were established to streamline operations and facilitate decision making at the local level. This, however, has resulted in duplication and a lot of waste. Many people argue that, as a result, there are now five ministries of health (that is, the central administration and four regional authorities). Given Jamaica's size, there should be only two regional authorities. This would reduce a lot of the duplication and address the top-heavy administration. Dr Winston Davidson had done a review of the health services some years ago, and the recommendations made need to be discussed and decisions urgently made.

Review some facilities

Jamaica has about 28 hospitals and 375 health centres. Many facilities have outgrown their usefulness and some are underutilised. These facilities should be reviewed and services rationalised. The previous administration acquired the St Joseph Hospital in Kingston some years ago. This hospital still operates as a semi-private facility. The beds are underutilised, with no more that 30 per cent occupancy, at a major cost to taxpayers. This facility should be sold or consolidated. Other health facilities should also be reviewed for underutilisation.

The Bellevue Hospital, for example, has a patient population of about 800, with almost equal number of staff. About 70 per cent of the patients in the facility are long-term patients who could be accommodated in cheaper facilities.

Cost recovery

The previous administration introduced free health care to all. This was neither wise nor sustainable. Many Jamaicans are able to contribute to their health care and they should. This includes persons who, by virtue of their income, can pay or who have medical insurance. Thousands of dollars in income is lost because we do not collect from persons with health insurance. In many countries, non-residents are expected to pay for their health care. The Government should introduce a sliding scale system of payment, which allows people to make a contribution based on their ability to pay. This will better enable us to operate the health service which is rapidly deteriorating under the current system.

Maybe the time has come for us to introduce a National Health Insurance Plan which will mandate all persons working to contribute into a health programme. Such a system has been successfully introduced in many countries in the region.

Financing pharmaceutical agents

Drugs used in the treatment of chronic diseases are subsidised under the National Health Fund. This is commendable, but the current list of drugs should be reviewed urgently. There are many items that could be removed from this list, and there is a growing tendency to include a lot of expensive drugs on the list when cheaper drugs are available. I think this is one area that requires urgent review.

Review salaries

Close to 80 per cent of the health ministry's budget goes to salaries and emoluments, and this should be reviewed. There are instances where people are paid on-call allowances and yet have never come out to work. Some doctors are employed at the grade-three level because there are not sufficient grade-four posts. They earn exorbitant salaries whereas savings could be accrued if more grade-four posts were created. There are many other instances that could be cited, and the reality is that the Health Ministry can cut its wage bills without sending home workers.

Better maintenance of equipment and facilities

The health sector loses millions every year due to a failure to maintain equipment and plan adequately. A better system of preventive maintenance is needed to prevent idle equipment and patients suffering from a lack of care. Institutions are tied to expensive maintenance contracts which result in us having to bring in expensive consultants to maintain and repair equipment.

This is not an exhaustive list, readers may have suggestions and we look forward to your feedback.

Dr Wendel Abel is a consultant psychiatrist and head, Section of Psychiatry, Department of Community Health and Psychiatry, University of the West Indies. Telephone 977-1108. Email yourhealth@gleanerjm.com.