Health and Wellness Minister Dr Christopher Tufton is again raising concern about the heavy financial burden the Government is shouldering in providing care and subsidised medications for people with non-communicable diseases (NCDs) such as diabetes and hypertension.

Questioning the sustainability of the Government’s continued subvention, Dr Tufton said allocations through the National Health Fund (NHF) to address NCDs have ballooned over the years, with increased coverage for 22 chronic illnesses.

The NHF helps pay for select supplies and services necessary for treating these conditions.

“The NHF budget has expanded substantially over the last five years, not only because of the increase in demand. We have moved from one million prescriptions about five, six years ago to about three million prescriptions last year. And the dollar figure has substantially skyrocketed to the point where you wonder if it’s sustainable,” he said during this week’s Jamaica Observer Monday Exchange.

In his sectoral presentation last year, Tufton had pointed out that medication costs continue to increase and, compared to the previous financial year, the budget increased for pharmacy services in the public sector by a projected 10 per cent or $1.1 billion and for the NHF card by 21.7 per cent or $1.59 billion.

That presentation also revealed that in the 2022 financial year the NHF served approximately 960,000 Jamaicans with free or subsidised medicines through 106 Drug Serv windows and 523 community pharmacies accepting the NHF card.

He said that of the more than 2.8 million prescriptions processed in 2022, approximately 8.3 million items were dispensed to customers for both outpatient and inpatient services. There were also more than 4.4 million claims for the NHF card at a cost of $6.43 billion in subsidies.

“There’s a sustainability issue, which is why we have been mooting this idea of a national health insurance scheme,” Dr Tufton told the Exchange.

In May 2019, Dr Tufton had tabled the National Health Insurance Plan Green Paper in the House of Representatives. The document is expected to lead to a final proposal aimed at providing appropriate levels of access, coverage, and financial protection to the population.

Dr Tufton told Observer reporters and editors that with more categories of illnesses added to NHF — including some cancers and sickle cell, and expanded support for diagnostic tests for the early detection of cervical and prostate cancers — “all of that combined has made the budget quite large”.

“We have to now engage in rethinking. Over time — I think over the next three to five years — the Government, the people, have to come together to decide what does it mean to finance and subsidise, because what we have now is literally, for the most part, a free system if you go to public service, or a subsidised system if you use the private, but you qualify under those 22 sickness categories. And NHF is available to everybody — rich and poor.

“And the question is whether or not the ones who can afford should be able to pay on their own and then reserve it for those who can’t, but then you get into means testing and people get slipped through the cracks. So, it’s a big question and a complex issue that has to be dealt with,” he said.

Dr Tufton, however, pointed to the Government’s compassionate care programme under which medication and hospital support are subsidised. This was at a cost of nearly $500 million last year.

“So what that means is that if you can’t get it by the NHF, or in the public system, you apply online. There’s a committee and the committee pays the bill and the demands on that have been quite significant. So, the cost implications have been quite enormous and it’s going to require some review at some point, but controlling the demand for these services is also a key one which is why primary health care is very important,” he said.

Highlighting the issue of sustainable health financing during his sectoral presentation last year, Dr Tufton had tabled a discussion document on the cost of health care.

“This is a critical paper that I will be using in the coming year to conduct a series of consultations with the Jamaican people on what type of health care system they require. The paper poses very important questions that we must, as a collective, answer,” he said.

The paper, he said, details: 1) the burden of disease within the population and based on our current health profile what costs are to be contemplated; 2) the costs of health and the gap that will be realised on the current trajectory of the sick profile of the population; 3) the issues of universal health coverage and what that means in the Jamaica context; 4) the Primary Health Care Model and the strategies for prevention that are essential to sustaining the way forward; 5) the many options for an essential package of care and what we, as a society, will need to agree on to safeguard our people for the future.

“The discussion paper on health care costing and the public discourse that will be undertaken will see the engagement of all stakeholders, including the private sector, the unions, the church, other non-governmental organisations and non-State actors,” Dr Tufton pointed out.

“We intend to move the conversation to the streets and lanes so as to get the widest set of opinions and thoughts as we craft the new system for health. At the end of these consultations we will present to this body a green paper that answers the questions posed. This green paper will complement the previous paper tabled on the National Health Care Insurance and together these documents will form the essential ingredients for formalising a resilient health system for Jamaica,” he said then.