MINISTER OF FINANCE CHRIS SINCKLER, who appears to have taken a firm grip on his own health – by admirably losing many pounds in recent times – now has the collective health of the country on his mind.
Giving a few glimpses into what might be in his Budget Speech coming up soon, Sinckler said public health was one of the “critical areas” that Government had been focusing on over the past few budgets and the Ministry of Health had been holding town hall meetings on the subject of public health financing, which costs the Government roughly $700 million per year.
This cost would likely continue to increase each year “because of the sophistication of medical interventions now and the sheer nature of the illnesses we face, particularly the chronic non-communicable diseases,” he said.
“The speed and manner, exponentially, at which health care expenditure is expanding has become challenging for the normal Consolidated Fund process of raising taxes generally and apportioning allocations of expenditure.”
A report five years ago from the World Health Organisation (WHO), called The Global School-Based Student Health Survey, found that nearly half of the school-aged population in Barbados was either overweight or obese. That survey also noted that almost three-quarters of all students drink carbonated soft drinks one or more times per day, and only one-third of students get enough exercise.
The Pan American Health Organisation/WHO Representative for Barbados and the Eastern Caribbean, Dr Godfrey Xuereb, told a press briefing earlier this year that in one generation, Barbados had moved from an island where a third of the children were malnourished to almost four in every ten adolescents being overweight or obese.
The message has not been lost on the Minister of Finance, who is seeing the cost of the nation’s increasing obesity show itself not only through the addition of pounds-per-square-inch on the average person, but the skyrocketing budget for the Ministry of Health, which is truly raising the economy’s “blood pressure”.
Sinckler said the Government had been looking at various models for financing public health and he hoped that by the time the Budget Speech came up, “we will have determined which one” to use.
The most pressing need, he noted, was at the “tertiary level” – that is, the Queen Elizabeth Hospital (QEH). The hospital’s management had indicated that the institution needs between $185 million to $200 million per year to operate, he said, but after negotiation the sum settled on was $165 million, which would keep it in operation while providing Barbadians with the level of care they required, he said.
The major portion of this would still be funded by the Government and the hospital would step up its efforts to raise revenue by charging fees to private patients.
However, what was needed was a new influx of revenue to help mainly with capital costs, that is, the cost of buying and replacing equipment. This would allow more of the recurrent expenditure provided by Government to go into day-to-day costs.
However, the Minister of Finance would not say how a new tax for public health would be raised, whether through the National Insurance Scheme (NIS), or another special tax.
In his last budget, Sinckler kept the cess being charged on fuel, which had been originally added to pay down arrears at the Barbados National Oil Company.
He transferred the revenue to the QEH to help pay off its arrears to suppliers. That tax raised about $35 million a year. All he has to do is double the cess and get $70 million a year for the QEH. But that would only be a stop-gap measure because it is a mismatch of tax revenue with expenditure.
We need a single-payer health care system here. We do have one already that pays for your care if you don’t have insurance or go to a polyclinic or the public wards of the QEH rather than the private ones. But clearly there needs to be a payroll tax added to the NIS (like the unemployment benefit tax, for example) which would be for health care.
See, I am not against taxation for its own sake. It is when you raise taxes and have nothing to show for it except for throwing good money after bad things that should be merged, abolished or consigned to the dustbin (okay, that is for another column).
Sinckler is also under pressure to restore the middle-class allowances which he gutted last year, perhaps in a fit of pique. Doing that would restore a lot of disposable income into people’s pockets and there would be a trickle-down effect.
It is not the only thing we have to do and that is why, painful as it is, I support the minister’s move on health costs, as I did on tertiary education. We are not the same as we were at midnight on November 30, 1966, when Errol Barrow stood next to Sir John Stow as the Union Jack was lowered.
We are more prosperous, more educated and more obese than in those days. If we don’t do something to chart a new course, we will lose all the financial gains we have made and keep putting on those extra pounds (of fat, not sterling).
