It is becoming increasingly worrying when a Government shows such confusion and uncertainty in its public policy. Taxation policies have to be reversed, tourism policies have to be reversed, imposition of taxes on allowances not clearly thought out, the accrual accounting not being understood by the minister of finance and now it is the turn of health policies.
There is no doubt that lots of things are wrong with the recent dispensing fee on free drugs. The first wrong is that a dispensing fee cannot increase with the cost of the drug, if so it becomes a tax. A dispensing fee is supposed to cover the transaction cost and so it has to be a fixed charge like a certain bank charge.
The second wrong is the incidence of the fee which bears no relation to the capacity of the user to pay. Incidence is fundamental to public policy especially when there is a charge involved.
The third wrong is that Government is saying on the one hand that cost is an issue and so the fee is necessary and on the other hand encouraging everyone to use a public sector pharmacy, which means that cost is not a factor.
The real issue is that this fee goes to the pharmacist which means that the pharmacist does not have to make a claim at a later date. In essence, the fee is expected to cover the transaction cost to the private sector pharmacist along with some profit.
It would have taken a substantial amount of research for varying costs of pharmacists to be known and certainly for their profit margins to be determined. There is much more in the mortar than the pestle!
What matters most is that the public has been called upon to pay the price in a way that is disproportionate to the individual capacities and this affects the incidence of the fee and so fundamentally changes the intent of the original drug-free service. This should not be taken lightly but only time will tell.
As if the dispensing fee is not enough, it was brought to my attention, and I have the evidence, that Barbadians are being asked to pay for health services at the Queen Elizabeth Hospital.
A woman is knocked down by a motorcycle in December last year and the cyclist remains unknown. She was taken to the QEH by ambulance. She was put on an x-ray machine to test the condition of her spine, pelvis and the lumbar area. She also received a CT scan. She was eventually charged for the services rendered and the drug. In total, the bill exceeded $1 000.
This is a Barbadian who gets a pension from Government. However, four months after the accident, a letter signed by the Director of Financial Services at the QEH reaches her, not even expressing concern about her condition, but stating: “We are desirous of recovering the cost of your care and thus request that you provide us with the name and address of your insurance entity.”
I would presume that if the director knows the lady’s address and her name that it would not be difficult to find out her age, status and eligibility for the services rendered.
In the circumstances, the letter conveys the notion that once the individual has an insurance entity, then it is the policy of the QEH to recover the cost of the services as the final paragraph read: “In the interim, please find enclosed a copy of the invoice which outlines the cost of your care which should be forwarded to your insurer to expedite payment.”
Nowhere in the letter does it speak to eligibility of the victim which leads to the conclusion that once the individual has insurance the policy is to recover cost.
There are many things wrong with this line of reasoning with respect to public policy formulation.
Clyde Mascoll is an economist and Opposition Barbados Labour Party spokesman on the economy.
