Chronic diseases driving up NHF expenditure
Published:Sunday | November 13, 2022 | 12:11 AM
As many Jamaicans continue to shun healthy lifestyle practices, chronic non-communicable diseases (NCDs), particularly diabetes, hypertension, heart conditions and poor circulation issues, continue to consume a large share of National Health Fund (NHF) expenditure in subsidising medication for such patients.
The NHF is a State entity which manages the Pharmaceutical and Medical Sundries Warehouse and public sector Drug Serv pharmacies on the island.
According to the NHF, the cost of pharmacy delivery in the public sector has steadily increased in the last decade from $2.9 billion in the 2011-12 fiscal year to just over $9.4 billion in 2020-21.
This is from an increase in the number of Jamaicans relying on the NHF card, which covers some 2,000 prescription items for 17 chronic illnesses. The infused JADEP programme, tailored specifically for persons over 60 years old, covers 77 prescription items.
According to the NHF, in the 2018-19 fiscal year, there were just over four million claims on NHF cards from some 262,485 beneficiaries. This was at a cost of $4.6 billion in expenditure, and is in contrast to 4.3 million claims in the 2020-21 fiscal year at a cost of $6.1 billion.
The infused JADEP component saw a significant increase in claims from 453,512 in 2020-21, at a cost of $247 million, to 504,902 claims in the 2021-22 fiscal year at $305 million in expenditure.
The increased demand has put heavy strain on NHF budget even as CEO Everton Anderson celebrated an increase in services being offered to Jamaicans, some of whom find it extremely difficult to purchase much-needed medication for their ailments.
There are 106 NHF-managed dispensaries, while the state entity engages 51 private pharmacies to serve Jamaicans in some of the most remote locations islandwide.
“We have been able to offer service in every single parish, in all major hospitals and health centres, and we have also been partnering with private pharmacies,” Anderson told The Sunday Gleaner, noting that cost is directly related to the increased number of persons accessing NHF services.
“We have moved from very limited access points to a significant amount of access points islandwide, and we have also been able to reduce the waiting time so more people are being served.”
The NHF is funded by 20 per cent of special consumption tax charged on tobacco products; as well as five per cent of the overall special consumption tax collected; five per cent on annual earnings up to $500,000 via the National Insurance Scheme; and from the Government’s Budget.
“Funds for the Drug Serv programme come from the Ministry of Health and Wellness,” said Anderson.
“We have had challenges in maintaining the flow of funds when compared to the number of patients seen, and what we have had to do each year is put forward for supplementary funds where the initial budget is inadequate,” he said.
The budget for the 2021-22 fiscal year was $8 billion, but the NHF has made requests for an additional $2 billion.
Nonetheless, Anderson emphasised that there is no shortage of drugs offered on the Ministry of Health and Wellness’ list of vital, essential and necessary drugs, more commonly known as the VEN list, which has seen a monthly fill rate of up to 90 per cent.
Consequently, the major challenges to the programme are the long waiting times some customers experience, and also the provision of items that are not on this list. Even in those cases, the NHF still assists individuals in acquiring the required treatment at subsidised rates, he said.
BIG SPEND ON HEART DISEASES
According to the NHF, last year, cardiovascular medication accounted for most of its spend in the public health sector at just over $1.5 billion. It was followed by drugs associated with the central nervous system at 1.2 billion, and malignancy at $860 million. Finishing off the list is endocrine medication at $563 million and infectious diseases at $455 million.
“The evidence is there that we served 283,000 persons in 2015-16. Last year and the year before, we were averaging nearly 700,000. We processed 945,000 prescriptions in fiscal year 2015-16, and the last two years, we are at 2.5 million scripts processed with a fill rate of 90 per cent,” said Anderson.
“This year, we are likely to double the number of claimants under JADEP, and we continue to make tweaks so the programme can provide greater benefits for the over-60 population. Over the next two months, we will be making announcements as to how access will be improved and more drugs will become available under both the NHF and JADEP programmes,” he said.