Explaining free health care to a 94-y-o
I recently had a patient complain to me about the way she was treated by a member of staff. Although she celebrated her 94th birthday in hospital, she was surprisingly very sharp and witty.
'Mama' did not like the way she was spoken to and asked that I do something about it. Of course, I had to ask her advice given the previous humorous conversations we had. She suggested I let that particular staff member and, indeed, everyone know that the patients are the reason we all were there. And that if no patients came, because of poor treatment, then the hospital would not collect any money and we could not be paid. I explained to her that the hospital was not collecting any money as health care was free in Jamaica. She was astonished.
She was probably wondering what kind of world was turning outside while she was lying in her bed. What other shocking developments had taken place since she stopped reading the papers and aborted watching the news?
"So, where does the Government get money to pay you? Is there a special tax?"
Now, to tell you the truth, I myself don't know where the Government is getting the money to plug the deficit caused by the abolition of user fees. I did know, though, and explained that there was no special tax or national insurance to cover the running of the hospitals and clinics, plus the additional multiple levels of bureaucracy that came about with the decentralisation of health care administration.
"But that don't make any sense to me."
"Me neither, Mama, but that's how it is nowadays."
"They should at least ask those who can afford it to pay a little something. It would help out."
That conversation had me thinking more about something that we in the health sector already know, but ignore: The current model for health care in Jamaica is not working and is unsustainable. As one colleague told me, she was hoping it collapsed soon, as that is the only way that the powers that be would try to fix it.
Critics of the current system are quickly cast aside as unsympathetic to the poor. I, however, had never seen a poor patient turned back under the old system. What I do see now more and more are patients with a sense of entitlement who take no responsibility for their health. We, the taxpayers, are left to foot the bill for their medical treatment.
But should you really be paying for the care of the daredevil who drives at 100mph without a seat belt? The motorcyclist who speeds without a helmet? What about the known diabetic who doesn't take his/her medication, even though it is provided free of cost. When their uncontrolled diseases lead to repeated admissions and expensive surgical procedures, should we foot the bill for their irresponsibility? What about the patient who annoyingly looked up from his smartphone and announced that he couldn't afford the $6,000 to pay for an ultrasound? Should he be taken to the theatre to do the surgery that turned out to be avoidable, while we pay for it?
The truth is money is being saved. But who is saving it? The health insurance companies who pay out less? Persons who really could afford to contribute to their health care, as 'Mama' pointed out? Indeed, we are told only of the poor who can't afford to pay anything but who would not have been turned away anyway under the old system. Indeed, these poor and destitute patients are still not fully catered for under the present system. They still can't afford the bus or taxi fare to get to the clinics. They still can't find food when they get hungry from the long wait to see the doctor. They can't get certain lab or radiological studies in the public system, and can't afford to have it done privately without skipping on a utility bill.
Such is the system which we pretend is okay, because we don't use it. But maybe identifying these vulnerable patients through a strenghthened social work programme akin to the Programme for Advancement Through Health and Education (PATH) would serve them better. Maybe a fee for service could pay for such a programme and still have funds left over to contribute to the running of the hospitals and clinics. Maybe putting the funds collected towards actually providing health care, instead of sustaining a bloated bureaucracy, would lead to the best bang for the buck. Maybe our leaders will start leading us towards a better place someday. Or maybe this is just a foolish dream.
Mama is home now. But the expression on her face when I told her what was happening in our health care system still haunts me.
Dr Alfred Dawes is a consultant general, laparoscopic and obesity surgeon at Premier Heart and Surgery Centre, and managing director, Mahogany Health and Fitness. Send comments to: email@example.com.