Saturday, April 20, 2024

THE ISSUE: Spiralling costs a determining factor

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OVER TIME, Barbados has developed a public health care system that is the envy of larger and richer countries.

While it has taken the powerful United States (US) many years to adopt a widely available and affordable health care offering – one that is still facing challenges by opponents – Barbados has had free universal health care for several years.

But as the population has grown and aged, with ailments, including chronic non-communicable diseases, and increasingly unhealthy lifestyles taking a toll on Barbadians, the cost of this free health care has become a hot topic and major worry.

The problem has been exacerbated by the fact that Government’s fiscal problems means the money it allocates for health care has become a burden.

It has prompted calls for a new public health care system where those who can afford to pay do so, while Government takes care of those who cannot.

Ideally, such a system would mean reduced demand for Government money to fund health care, including for most Barbadians who utilise the services of the Queen Elizabeth Hospital and polyclinics.

Speaking last July at a ceremony to celebrate the 25th anniversary of Bayview Hospital, Minister of Health John Boyce announced that his ministry was preparing proposals to reform the health financing system.

He said the challenge was finding and establishing a sustainable health financing model that would ensure Barbadians received the best care at an affordable price.

“Even as we seek to give Barbadians greater assurance of continuous improvement in our health care system, we must not inadvertently create a financial challenge for future generations,” Boyce said.

He reiterated the stance two months ago during the Estimates debate, especially in the context of funding for the Queen Elizabeth Hospital.

“I believe the debate in Barbados has reached the stage where we are ready to entertain some sort of contributory investment health care fund, which would see to the provision, on an annual basis, of some of the urgent and important supplies at the hospital.

This is absolutely urgent, especially in this technological world,” Boyce said.

Experienced physician Dr Colin Alert recently said that Barbados was “probably” in a “health care financing crisis for a long time now” and that there was a need for urgent change.

He said Government’s spending on health in 2009 was more than 11 times higher than the spending in 1976, moving from more than $35 million to more than $383.6 million in that time. While the population grew from 247 000 in 1976 to 275 000 in 2009 – a 12 per cent increase – health care spending increased by more than 1 100 per cent.

“Over the 37 years (and unfortunately continuing), we have seen the emergence of an epidemic of chronic non communicable disease patients on whom most of the spending occurs. We have not seen any effort to prevent this epidemic,” he said. He also pointed to inefficient spending of the funds allocated for health.

“What we have in Barbados is a lack of returns from this massive spending spree in the Ministry of Health. The Government ministry traditionally gets the largest chunk of the national budget, in the area of 13 per cent. In the 2015 to 2016 Estimates, a proposed drop to 8.9 per cent was quoted.

“This is the finance side of the health financing debate. Unfortunately, because of the way our health decision-makers have traditionally approached the nation’s health, the reduced financing is likely to further compromise the individual health,” Alert added.

The need for urgent action was also highlighted by QEH chief executive officer Dr Dexter James.

Delivering the 22nd Annual Louis Lynch Memoral Lecture on Universal Health Care And Sustainability: Our Reality, he said: “The gains that the Caribbean has made in terms of immunisation levels, good maternal and child health will be lost and eroded if we do not address this question of health care financing. It is no longer an option; it is really an imperative for us today.”

The QEH alone uses a large amount of the public financing support. It is estimated that it costs $15.8 million monthly to operate the QEH, including payroll ($9.5 million), medical supplies ($1.7 million), drugs ($1.5 million), utilities ($1 million), and operating expenses ($1.6 million). 

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