SSP Diaries | Access to affordable healthcare

One of the requirements for good democratic governance is an affordable healthcare system for the people. Has this been something that we have ever managed to achieve in our history? Many years ago, as a child, I remember it was not unusual for the services of the private practitioner, in the countryside, to be paid in kind. The poorer people in society would offer what they could, ground provisions, fruits, etc., as payment and this was accepted. Although not standard practice for everyone, it was clear that some could afford to pay with money and some in kind, affordability was never something enjoyed by all.

The alternative was always going to the public hospitals to be treated for free but, in such cases, you stood the chance of suffering more because of the volume of people, poor waiting facilities and the long wait for treatment that ensued. This system was never an efficient one for providing adequate healthcare to patients.

Today, the public hospitals offer a service which I am not quite clear on whether it works or not, as those who are deemed capable of paying are billed accordingly but I am yet to understand if this is a workable solution in the society in which we live, because of the difficulties of collecting. The semi-private or privately owned hospitals are in a category all by themselves. It is the norm these days for patients to be delivered to these institutions, with life-threatening injuries, only to be told that they cannot be attended to unless there is proof of payment of the cost of tending to one’s injuries or current condition. The ordinary man hit down by a motor vehicle or involved in a serious accident is not likely to have the means of paying for serious medical care to save his life. Unless he can be taken to our recognized regional trauma centre, the Kingston Public Hospital (KPH), he is likely to die waiting for treatment on the very stretcher he is being transported upon. The matter of providing a health or life-saving service has become secondary to that of preserving the current business model. Payment to tend to the condition presented becomes the primary concern and, where this is not forthcoming, patients are known to be transferred to public hospitals for immediate treatment. Healthcare institutions should all be mandated to save lives first at every instant and not be money-focused, that is priority healthcare.

AFFORDABLE EQUITY

How can we as a nation survive under the present dispensation? One is being mandated not to be sick in your lifetime, especially as you grow older, or, migrate when young to a country that values the lives of its citizenry. Medical insurance as a concept is a valid one. However, it fails miserably when each year the premiums increase and, to the extent that there is no commensurate increase in salary, it becomes unaffordable in a relatively short space of time. Pensioners are in a serious plight. They have no means of increasing earning power to meet the demands of increased medical costs, as they are on fixed incomes for life. They receive no special privileges and are subjected to the same cost increases faced by the salaried workers. In essence, the country does not accept any real responsibility for the life of a pensioner. In our own colloquial terms, such people have been ‘put out to pasture’. As a pensioner, heaven forbid that you require a major procedure to be done and have been juggling your insurance coverage over the years. You may find that you are no longer covered for major surgery and may have to face a stark reality of death earlier than envisaged.

The cost of medical care for a significant percentage of Jamaicans has gone through the roof. It is simply unaffordable and, even when affordable becomes life-threatening thereafter, because most people will have no means of recovery after such expenditures. Our healthcare system has moved from one providing a service for its population to one in which money is the primary focus and huge profits are the ultimate solution. It is affordable for a few and not the majority. We have even reached the stage in the delivery of a health service where the fees to be paid on weekends are far more than those paid during the week, for the same service! Being ill during the week attracts a different price from having the same ailment over a weekend or on a public holiday! What a calamity.

Government needs to investigate this with a view to providing greater affordable equity in the access of reasonably priced healthcare. Affordable healthcare is a right for everyone and not the rich alone. Healthcare must return to being a public service across all institutions, as opposed to being solely business-oriented profit-making entities. The plight of the poor must be addressed and, in the delivery of a free service, they must be treated as human beings and in a dignified manner. It is time that pensioners have their pensions index linked to the cost of living and be offered healthcare benefits that will assist them in having acceptable lifestyles as permanent fixed income earners and people that have already given their working years in building their country.

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