Garth Rattray

The 2007 Jamaica Labour Party (JLP) manifesto promised 'Unrestricted, universal access to health care'. Section 27.5 reads, 'Free public hospital care: Abolish user charges at all health facilities including public hospitals'. The JLP promised to (concomitantly) review, upgrade, improve, finance and expand the existing public health facilities. They also promised to increase the availability of medical personnel in short supply and to explore telemedicine technologies and health tourism. Well, tomorrow is D-Day.

Beginning tomorrow, everyone accessing the public health-care system is promised abolition of fees for: registration, doctor's examination, hospital admission, surgeries, medications, diagnostic services, renal dialysis, ambulance service, physiotherapy, family planning, pregnancy tests, antenatal services, delivery and immunisation.

I believe that the Government as bitten off much more than we can chew. How can we afford to abolish public health care fees totally when, the prime minister, in his address to the nation (March 19, 2008), announced that, "The economy is caught in the middle of a global economic cyclone that is battering even countries with strong economies"?

Horrible timing

Undoubtedly, abolition of user charges is a great idea but the timing and execution are horrible. Hospital and clinic fees were prohibitive for our very poor; although many were staying away, some attended without paying. In addition to the ongoing lack of funds, there were huge problems with the chronic unavailability or paucity of staff, services, medicines and equipment.

The Government has put the cart before the horse. Public hospitals and clinics should have had an increase in personnel and, been reviewed, upgraded, improved, better financed and expanded long before instituting no-user-fee healthcare. Our shaky, understaffed, under-equipped and underfinanced public health-care facilities cannot withstand the estimated 30 per cent increase in demand for services.

Several knowledgeable stakeholders have been voicing their concerns and suggestions. Government-employed doctors agree in principle with the no-user-fee health-care policy but have been emphatically advising (in vain) that people attending public clinics and hospitals pay according to their means (resources). Patients should be assessed based on their employment status, health insurance status, income, savings and assistance from relatives here or abroad.

Lack of equipment

The expected surge will produce crowds of irritable (and potentially violent) patients and relatives at public clinics and hospitals. Health care will be 'free' - but perhaps only on paper - because, the lack of requisite staff, reagents for blood investigations, material for X-rays, medications and various equipment (for investigation and treatment), will render many services unavailable and/or necessitate outsourcing.

One of my colleagues predicts a threat to the viability of businesses that are already owed many millions of dollars but are still supplying medical goods and equipment to the Government.

He envisions disastrous repercussions in the public and private health sectors. He went on to remind us that undergrad and post-grad medical science training also takes place at several public hospitals and therefore stand to suffer.

The Medical Association of Jamaica (MAJ) has welcomed universal access to healthcare since many citizens simply cannot afford public hospital and clinic user fees. It, however, views this as 'utopian and difficult to achieve all over the world'. It cited many existing problems in the public health sector and outlined the need to address them immediately.

Since this administration is committed to make good on its political (campaign) promise in spite of all the drawbacks, I join the MAJ in looking at the situation as an, 'excellent opportunity to review the needs and organisation of our public health sector'. Perhaps in so doing, we can minimise the predicted impending chaos and catastrophe.