Editorial | Rethinking user fees
We accept that no Jamaican should be denied access to healthcare because of an inability to pay. Sadly, there are thousands of Jamaicans who cannot afford basic healthcare and have to forego a doctor’s visit or not fill a prescription. These are most likely the folks whom the Government had in mind when it committed to the tenets of a publicly funded healthcare system by abolishing user fees in hospitals (except The University Hospital of the West Indies) and clinics across the island, in 2009.
At the same time, we acknowledge that someone has to pay for services, such as surgeries, diagnostics, hospital accommodation and drugs. That someone is the taxpayer. By abolishing user fees in clinics and hospitals, the Government stepped in with taxpayers’ money to provide these services, not just to people who could not pay, but to anyone who wanted to access the public system.
This decision was partly motivated by concerns of the World Health Organization (WHO) that ill-health and the high costs associated with getting medical care were deterrents to the realisation of poverty-eradication goals for countries like Jamaica.
It was argued that, by abolishing these user fees, more people would confidently go to public health facilities to seek care, which would eventually contribute to healthier, more productive populations.
From all accounts, after the abolition of user fees, patients poured into these facilities in search of treatment. It was reported in the first year after the fees were abolished that 16 per cent more patients were seen. The big question today, however, is this: Has the abolition of user fees improved equitable access to quality health services? If we listen to the assessment of Spanish Town Mayor Norman Scott, the answer is a resounding no.
He had this to say recently: “People go to hospital and they spend days on a bench before actually getting a bed. In some cases, before they get a bed, they have to go elsewhere to get scans and other tests done, because they are not available at public hospitals.”
Additionally, a nationwide survey of public hospitals carried out by the Caribbean Policy Research Institute (CAPRI) points to the loss of financial resources which have negatively affected pharmaceutical and medical supplies, staffing, waiting time, space, service delivery and processing time.
This survey shows up some of the unintended consequences of the abolition of user fees. It seems that the switch was not as easy as anticipated back in 2008. The announcement of free healthcare was heartily welcomed as a smart political move. But, after the announcement, it was then left to the ministries of health and finance to provide the requisite resources for the key components necessary to deliver a properly run, national healthcare system.
As the years went by, with diminished ability to finance healthcare and respond to emerging technology needs, the complaints have grown louder. From patients who suffer in crowded hospital corridors to overburdened medical staff, the clamour is for more resources to be made available to the health sector.
An unpredictable health event such as COVID-19 showed just how fragile the healthcare system can be when there are matters such as supply chain issues, labour shortage and increased costs to absorb. The powers that be cannot continue to ignore the calls for reform in the health sector. For example, an effective budgeting process will manage cash flow and prioritise capital investments to align with national goals.
And it may very well mean reintroducing fees for those who can afford to pay. The growing calls for a rethink of the no-user-fee policy are timely and of national significance.