Tufton aims to redesign health finance, push efficiency
A 10-year strategic plan for health — funded by the IDB — is being developed as the basis on which the Ministry of Health will pursue plans to restructure that department of government, Minister of Health Dr Christopher Tufton tells the Jamaica Observer.
Meanwhile, he says, he has a slate of interim measures for the reduction of waiting time and increasing the efficiency in the public health sector. Those which are feasible, he says, he fully intends to implement.
Aside from the well known impact of illness on productivity, the 2001 World Bank study, Macroeconomics and Health: Investing in Health for Economic Development, says health and the wealth of nations are interconnected.
Among the strategies being considered by the Ministry of Health is the reduction of regional health authorities to two instead of the current four, and the roll-out of public-private partnerships (PPPs) in which private providers bring to the sector new equipment and services which are needed in exchange for which they are set to get a vastly higher level of traffic for their services.
Restructuring goals include upgrading clinic services to reduce the workload of hospital emergency services.
The first of such, completed at Bustamante Children’s Hospital in Kingston, cost $300 million, adding new equipment and personnel and extending the closing time from 4:30 pm to 8:00 pm for the clinic.
In one PPP pilot, the ministry also incentivised pharmacies in Clarendon to distribute drugs, thereby reducing waiting time for drugs at the hospitals.
A creative approach, Tufton said, is necessary in light of the restricted spending on health from central government, the established policy of no user fees, and the commitment of the current government to providing universal health care as a right.
The Ministry of Health was assigned $52.90 billion for recurrent expenses and $1.54 billion for capital projects at the start of the 2016-17 financial year. The amount, says Tufton, is not enough to meet the needs of the population.
“Part of the challenge we have is a policy of embracing universal access captured in a type of free health care, or no user fee. If you go by the benchmarks such as those set by the WHO (World Health Organization), there is a recommendation that in the interest of universal access six per cent of GDP should be allocated to health. We have in the region of three per cent. The logical consequence is less than sufficient resources to support health,” the minister told the Jamaica Observer.
“It is true there are some inefficiencies. In fact, in some instances one can do much better. For example, the structure of health care — the regional health authorities — restructured, we could achieve better value for money. But aside from such variables, the sector is underfunded. We are definitely underfunded.”
Data from the ministry indicates that whereas Barbados spends 4.7 per cent of GDP on health, the Bahamas 3.6 per cent, Canada 7.4 and the UK 7.6, expenditure in Jamaica is 2.8 per cent of GDP. The island keeps company with Trinidad where only 2.9 per cent of GDP is expended on health.
Measures also under consideration for Jamaica include a proposal to increase contributions to the National Health fund, review of the sin tax (tobacco levies) which funds the NHF, and review of drug usage in local hospitals.
In relation to a possible hike in the sin tax, he commented, “I don’t think you can take anything off the table.”
Tufton adds that with about 20 per cent of the population having private insurance, he is determined to collect from them where they use public health services.
The minister is gung-ho about the PPP project, noting that the private medical community which partners with the public sector will get much higher throughput, hence payback for their investment. “It is going to be a much greater collaboration with private partners,” he commented.
The minister of health indicates that he is prepared for pushback in some areas of the changes proposed.
“We are going to think radically. I am not here to preserve the status quo. I am here to shake it up, bearing in mind the needs of those who need the services, and holding those who are in charge accountable.”