Gareth Manning, Gleaner Writer

CLOSE TO to half a million Jamaicans with health insurance can still expect to pay indirectly for services and items in public health facilities from which user fees are to be removed come Tuesday.

Speaking with The Gleaner yesterday, Minister of Health Rudyard Spencer says while insured persons would not be required to co-pay for services, insurance companies will still be billed to cover a portion of the cost.

Insurance companies currently cover 80 per cent of the insured's expense for health services and medication. Close to 20 per cent of the population have health insurance, according to the latest Survey of Living Conditions by the Planning Institute of Jamaica.

"We have had exhaust(ive) discussions ... and those persons accessing the public health facilities will be asked to present their card, but that 20 per cent - that co-payment that they would be required to make - would not be made," Spencer told The Gleaner.

This means several people who purchase health insurance might still indirectly pay for services and items from which user fees have been removed.

In many organisations, health insurance is a normal item offered, or mandated, in employee salary packages for which workers contribute.

President of the Jamaica Employers' Federation, Audrey Hinchcliffe, says most companies share the cost for the coverage by paying 80 per cent for their employees, but commonly the cost is split in half.

"I do not know of any rich company that (pays) all of it," she says.

The action by Government could, therefore, lead many workers with health insurance to consider whether to continue paying for health insurance coverage in order to access the particular items and services that will be provided free in public health facilities.

Not casting judgement

President of the Bustamante Industrial Trade Union, Kavan Gayle, says it is a concern the union has, but he is waiting to see how the system will pan out before casting judgement.

"Definitely, it's going to be a concern to us," says Gayle. "We are going to have to examine (the) impact of it ... . We would be discussing it with our membership to see (if) it will affect the various persons in the public sector entities," he adds.

President emeritus of the National Workers' Union, Clive Dobson, says while it was not an immediate concern, it certainly means that workers would be getting the services free.

However, Spencer has rubbished that argument. He says what employees are normally required to pay is an additional amount for dependents and not for themselves.

"The company provides the health insurance for their employees and employees pay an additional amount for the coverage for dependency," he argues.

No concerns raised

He adds that the concern was never raised by any union or insurance company.

"I don't want to get involved with that because you (this reporter) are the first person to raise that. None of the unions raised that; the Medical Association and the Nurses' Association never raised that."

The move might also cause some elderly - who are in greater need of care - to pay for the free health items and services the Government will start delivering tomorrow.

According to the latest Survey of Living Conditions, persons 60 years old and over make up more than a quarter of those with health insurance. Most have private health insurance.

When asked if he was aware of the data, Spencer responded that he was not: "I don't know that. Because the majority of the people who are working are not the elderly. I don't want to get into a debate about that because this is not what this is about," he says.

The Ministry of Health got a boost of $100 million in the 2008/2009 Budget to assist with preparatory activities for the abolition of user fees in all public health facilities, except the University Hospital of the West Indies, come Tuesday.