NO issue touches people the same way health care does. This is why the provision of health-care services is the fundamental factor that determines those vital indices which record the country’s overall progress. It, however, comes at a cost, and in Barbados’ case is 8.7 per cent of the gross domestic product – or $732.7 million.
This is unsustainable.
While we can still boast of the state’s expenditure on education and health, the new economic environment requires not only greater accountability and transparency, but also adjusting to doing more with less. So the ongoing national discussion on health-care financing must also be linked to overall health-care reform.
Barbados needs a mixed financing system where, because of competition, the public will secure good health-care outcomes. But where entrepreneurial risk-taking is encouraged, there must be returns on capital given the investment in technology and training. Undertaking research and publishing bill sizes to show costs variation among public and private health-care facilities may be the good step forward in such an environment.
Our attempts at universal health care is part of the long-standing social welfare system the country has adopted and which encouraged an unacceptable level of mendicancy among many citizens.
The belief is that paying taxes means free access to a myriad of services, health included. But the scope and variety of services now expected and demanded cannot all be realistically provided pro bono.
What must be agreed on is that the health-care system ensures that access is not limited to only those who can pay.
This is why we must determine whether the public sector should lead in the provision of acute and chronic care while the private sector becomes the dominant player in primary care. Provision must also be given to charting a new role for the network of polyclinics, whose services – both in terms of specialties and operating hours – must be reviewed to make them viable health-care facilities.
The challenges presented by an ageing population cannot be ignored, given the need for nursing homes and long-term care that call for a mix of public and private inputs. Neither should we lose sight of specialised services such as mental health care and addiction treatment, which cannot be downplayed.
The impact of non-communicable diseases on the cost of health care has been well articulated and that is why the role of the national drug service is so important in the ongoing debate.
There is a clear case for seeking the best combination of roles by mixing the public and private sectors. The country urgently needs a workable solution that redounds to the benefit of the majority without being a burden on the state. This is an issue on which the people must make their voices heard.