What is worse than creating bad policy is its bad implementation. But worse still is to maintain that policy once it has been recognised to be bad.

This is why we welcome the fact that despite his muscled huffing, Health Minister Rudyard Spencer has commissioned a review of the Government's decision more than a year ago to eliminate fees at state-run hospitals and clinics. It was a move in keeping with the Jamaica Labour Party's promise to go beyond what was done by the previous administration.

This newspaper is not against free health care or, for that matter, free anything by the State, except with one proviso. We have to be able to afford it. And on the evidence, there are few services that the Jamaican Government is able to afford at appropriate levels and quality.

Indeed, even before the global financial market crisis and the recession that it has triggered, Jamaica faced dire economic circumstances. The country's debt hovered around 140 per cent of gross domestic product (GDP) and required nearly 60 per cent of the Government's annual budget to service. Economic growth over several years has been anaemic, averaging under two per cent a year.

A significant part of the problem has been a bloated, gourmandising State gobbling up too much of the country's resources, leaving too little for the private sector to invest to create jobs and national wealth. In the current fiscal year, for example, the Government projected to run a fiscal deficit of 4.7 per cent of GDP - a rate it is struggling to meet, despite its attempt to rein in expenditure. A downturn in the economy has constrained tax revenue.

In the grander scheme of things, removing hospital fees, of itself, may not be such a big thing, except that in difficult financial circumstances, every penny counts. In 2006/2007, the last financial year when full hospital fees were in place, the Government projected to earn $660 million from patients. That was just under five per cent of the $13.2 billion it allocated for health services.

At that time, it projected that more than 570,000 out patient visits would be made to hospitals and that more than another half million would use casualty/emergency services. The projections in the budget documents for the current fiscal year are surprisingly similar to those made three years ago.

Recent budget adjustment

To be fair, however, the recurrent budget for the current fiscal year, even before a recent adjustment, was 70 per cent higher than 2006/2007. But the health sector was always underfunded and in any event, the increase has to be discounted for inflation, which last year alone was over 17 per cent.

We do not know whether universally free hospital service and clinic services have, as a committee appointed by Mr Spencer had concluded, "undermined the primary health-care system and pushed the country in a service-delivery tailspin". But the anecdotal evidence suggests that it is creaking under the weight of the unleashed demand, even by people who can afford to pay something.

It would make better sense, in our view, if people who can pay were required to do so. Appropriate means tests are available. The same applies to 'free' secondary education.

A full review is necessary as part of the tax package at Budget time.

The opinions on this page, except for the above, do not necessarily reflect the views of The Gleaner. To respond to a Gleaner editorial, email us: editor@gleanerjm.com or fax: 922-6223. Responses should be no longer than 400 words. Not all responses will be published.