Alfred Dawes | The democratisation of private healthcare
It is no secret that Jamaica has lost its place as the healthcare leaders in the Caribbean. The opening of The University College of the West Indies Medical Faculty in 1948, guaranteed that access to medical training would be sustained and not limited to those who could travel overseas for training. With the faculty based in Mona, St Andrew, naturally, the pioneers of medicine would flock to and remain in Jamaica. Jamaica led the way in research and the introduction of new treatment modalities for decades. This naturally led to our people being the beneficiaries of quality healthcare throughout the countryside.
The inevitability of nationalism to trump regional cooperation post-Federation led to other islands developing their own medical faculties. Progress in medicine was democratised.
In other islands, it has been the combination of the private sector and Government spending that has propelled the development of their healthcare systems. Jamaica has lagged behind because of the deficiencies in these two pillars of healthcare. Consecutive administrations have refused to spend the nine per cent of gross domestic product (GDP) on health suggested by the World Health Organization (WHO).
With anaemic economic growth throughout our post-independence era, very few Jamaicans can afford private care. The result is that our spend on health is 5.4 per cent of GDP; a little more than half of what is needed.
Chronic underfunding, staff shortages, inefficiencies in the deployment and management of material and human resources, poor management and the exploitation of systemic weaknesses by dishonest employees wreak havoc on what was once an exemplary public healthcare system.
The reforms needed to fix the system will cost any government an election, so we can forget about any actions, save patching of healthcare potholes in true Jamaican style. If Jamaicans are to get access to quality healthcare, it is the responsibility of the private healthcare system to provide that care. However, it is the prohibitive cost of private care that has stymied this growth. The cost of private care can vary anywhere between two and six times that of other countries with similar GDPs per capita. Whereas this difference can be partially attributable to the impact of economies of scale, there are other contributing factors that cannot be ignored.
Anybody who has been to a private hospital in Jamaica has first-hand experience of the astronomical costs that can only be covered with insurance. The problem is that only approximately 20 per cent of Jamaicans have medical insurance. For the others who cannot come up with the funds, they are forced to join long queues in the public hospitals.
The reasons for the high costs are multifactorial. The inputs into private care involve human resources, supplies, and operational costs, for example, utilities and equipment maintenance. Whereas nurses and other staff employed full time by hospitals are paid cheaply, compared to other countries (hence the migration crisis), doctors who are paid professional fees separately from hospital charges do not come cheaply. Compared to what doctors are paid in developed countries, the fees are heavily discounted. However, when compared to other countries within the same GDP per capita band, the fees are higher.
The model where a hospital employs specialists directly and bills patients for their services results in lower payments to the specialists but the savings are transferred, not to the patients, but to hospital administrators whose priorities then become earning profits and securing their bonuses, not care for those in need.
Healthcare providers who do the actual caring are not paid their true worth. Such has been the case in the United States, where physician compensation has steadily fallen since the introduction of Health Management Organizations, while the chief executive officers of these HMOs fly in private jets.
PASSING SAVINGS TO PATIENTS
If there is a move to lower provider costs, there must be a fair way of passing on the savings to the patients. If doctors, nurses and allied health professionals were to form an organisation where they could reduce costs to patients directly and profit from the increased numbers, then able to access care, it would be a win for everyone.
The costs of the same medical supplies in Central America are sometimes a quarter of that in Jamaica. These countries are able to provide care to thousands of medical tourists at a fraction of our costs, while we congratulate ourselves as to how much cheaper we are than in the US. Distributors of medical supplies in Jamaica add huge markups because they move less quantities so they gouge the end users more. In addition, the import duties on medical equipment and supplies significantly add to the costs.
The Omnibus Incentive Regime selects only ad hoc items for waivers, with no coherent scheme in place to foster the growth of much needed services such as dialysis, transplant, laparoscopy or cancer screening.
Until the material inputs are at a lower cost to end users, private healthcare will never be affordable to the common man.
Electricity costs are simply ridiculous. With health facilities requiring a cooler ambient temperature for infection control, utility costs are a major factor in patients’ hospital bills. Maintenance and repair of North American and European made equipment come at a premium when compared to Asian-made instruments but who is here to repair those, and with what parts?
Put this all together and you will see why the waiting lists are so long at public hospitals and why it may be cheaper for the Government to fly patients to Costa Rica for surgery than to pay to have it done privately locally. This has to change.
Dr Alfred Dawes is a general, laparoscopic and weight-loss surgeon; Fellow of the American College of Surgeons; former senior medical officer of the Savanna la Mar Public General Hospital; former president of the Jamaica Medical Doctors Association. @dr_aldawes. Email feedback to firstname.lastname@example.org and email@example.com