FILE
Health care delivery often involves several overlapping interests seemingly in conflict with each other - doctors, patients, administrators and government.

Dr Joseph Bonsu-Akoto, Contributor

The major players in the 'arena' of health care delivery are patients, employers, hospital administrators, (doctors and nurses as well), insurers, and the Government. All of the mentioned players have specific targets they want to achieve, but they often seem to be in conflict with each other.

As a whole, we can all agree that "health care is a social good; an essential part of the social infrastructure that facilitates individuals, families, communities and business success. All individuals, whether old or young, employed or unemployed, ill or well, should have health care coverage". (Gene Farley).

To Farley, "It is unethical to make investor profits from denying health care coverage". Patients are in a position of need, not choice as in the economic issues. But, should that mean making health care delivery free to all, including the richest amongst us? Anything free in a society that could have been performed by the private sector creates economic failure because of inefficiencies.

Moral examination

Laura Nash, in an article titled: 'Ethics without the Sermon', said: "How one assembles the facts weights an issue before the moral examination ever begins, and a definition is rarely accurate if it articulates one's loyalties rather than the facts. The importance of factual neutrality is readily seen. As a first step according to Nash, is defining fully the factual implications of a decision in determination to a large degree the quality of one's subsequent moral position. A truly moral decision is an informed decision. One simple test of the initial definition, according to Nash, is the question: How would one define the problem if the person stood on the other side of the fence? And, Nash's third question is equally important. How did the situation occur in the first place? As important as deciding the ethics of the situation, to Nash, was the inquiry into its history. Indeed, the history can give a clue to solve the problem. An example of that history is United States Medicare and Medicaid. Even though the United States spends approximately 15 per cent of GDP, 45 million of its people still do not have health care.

The challenges facing today's health delivery system is cost-containment and affordability. Among the issues confronting governments are scarce resources, problem of the AIDS situation affecting millions, the 'baby boomer's needing long-term care, access, challenges to solve the distribution of doctors in some geographical areas, malpractice litigation proposals for future financing, cost containment, fees structural issues, just to mention a few. Can you imagine what could happen to the economy if there is no adequate way to pay for these problems mentioned earlier? The enormous range of targets for intervention in health care is made possible by the fact that health is determined by several related factors. Among these health determinants, none is more important than the physical, social, and economic environments in which people live. In addition, health is strongly influenced by lifestyles and heredity, as well as by the type or quality, and timing of health services, that people receive.

Vulnerable economy

Making it free to even those who can afford it makes the country's economy even more vulnerable to external factors. Rather, the resources are needed to improve both the primary and secondary cares. Looking at the problem from 'cure' rather than "prevention" might prove very costly in the long-run.

Health issues are intertwined with other important areas of public policy. For example, environmental policy is often shaped by the need to protect human health from harmful pollutants. This has been influential in the creation of clean water, breaches and clean air legislation and in the development of toxic or "garbage" dumping regulations. That area needs to be revisited to reduce health costs. Some experts argue that unless emphasis is placed on cost-effective approaches to the delivery of high-quality health care and apply how health care organisations can ascertain modern quality assurance methods to help recapture control in a time of frustration and skyrocketing costs, the health care delivery is doomed to fail all stakeholders.

On April 1, health care in the government hospitals is set to become free. On the surface, it sounds like a fantastic idea. Yes the idea of helping the poor to attain proper health care is fantastic. But the implementation is wrong. Not everybody in the society is poor. Giving free health care to all is bad economics at a time when government deficit is so high. The question one needs to ask: Does Jamaica have the economic structure to make such a bold step of free health care without a needs assessment? Saying that free health care would be expensive is an understatement. Taking into consideration the trade and budget deficits as well as the huge national debt, is total free care for all needed now? Yes and no. Whatever the case may be, the Government should perform empirical studies to find a means to give only certain income groups a free pass.

But as important as health care is, a universal free pass is not the answer. And, even for political consideration, a needs assessment is still necessary.

Dr Joseph Bonsu-Akoto is a former policy research consultant and management support adviser at the Ministry of Health and Human Services, Cayman Islands. He may be reached at jakoto@yahoo.com.