The demand for health care at public health facilities far exceeds their capabilities. While the dilapidation of infrastructure and limited resources contribute to the inefficiencies which exist within our public health-care system, another major cause for concern continues to be our free health-care policy.

Every Jamaican should have access to health care regardless of their financial standing.

While I agree that this is a fundamental right that every citizen should enjoy, I believe the Government of Jamaica (GOJ) should revisit and revise this policy in an effort to ensure that the most marginalised and vulnerable groups in our society are protected and have continued access.

A targeted approach to free health care in public facilities should, therefore, be conceptualised and introduced. This targeted approach should identify members from these vulnerable households and grant access to free health care, accordingly. If needs be the GOJ may even choose to increase the band of access and make stipulations based on predetermined socio-economic factors. We must all play our role in helping with the development of our country. Those who can afford to pay should pay, while user fees should be waived for our vulnerable groups. In 2008, the fees forgone by public health facilities, due to the abolishment of user fees, was estimated in the region of $450 million. This represents a reduction in well-needed financial resources which could have been used to further support and maintain our resource-constrained public health system, coupled with the annual funding received from the GOJ.

Another alternative is that, in addition to only selected segments of society having access to free health care, the GOJ could also consider subsidising the user fees payable by members of the public who do not fall within the vulnerable groups of society. This will keep the user fees low and still guarantee an additional source of revenue for our public health-care system.

The GOJ should also invest in more public education campaigns to drive greater awareness to the types of hospitals and health centres that exist within the country so that Jamaicans will possess the ability to exercise greater discretion when accessing these public health facilities. For example, a relative of mine suddenly fell ill and started experiencing difficulty breathing. We knew she was previously admitted to Port Maria Hospital and, as such, knew the hospital would have her health records. With the best intentions, we made the decision to rush her to that location; however, upon arrival at the hospital, we were initially advised to make alternative arrangements to have her transferred to another type of facility as their hospital is Type C, which does not specialise in respiratory conditions. They eventually admitted her, but many resources could have been saved (both on our end and theirs) if we were aware of the types of facilities that exist and could have used this knowledge to make a better-informed decision.

User fees should be reintroduced within the public health-care system to the segments of the society that can afford it. I believe this is the best balance that exists as it ensures much-needed additional revenue to our public health facilities and simultaneously protects our most vulnerable groups in society who will still enjoy access to free public health care. It will, in essence, help to lessen the inefficiencies that exist between supply and demand at our public health-care facilities and also balance the conversations that exist for those in favour of and those against Jamaica’s free health-care policy.

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