The most recent data show less than one-quarter of Jamaicans have health insurance of any kind.

According to the National Health Plan green paper tabled in Parliament (2019), about 500,000 people of the 2.7 million living in Jamaica have health insurance, leaving behind more than 80 per cent of the population to fund health care out of pocket, engage in months-long waits for diagnostic tests or surgical operations, or wait hours to receive general observation.

The consequence of this is delayed medical care, worsening health conditions, and an overburdening of the public health system as many hope for a date for surgery.

The latest edition of the Economic and Social Survey of Jamaica (ESSJ) published in March 2022, records an increase in chronic non-communicable diseases (NCDs), which require life-long management and interaction with the health-care system. NCDs increased in 2018 by 2.4 percentage points to 26.3 per cent.

A visit to public health-care clinics can be a marathon event, entailing hours of wait, with many in pain while they wait. Testing to support diagnosis in the public health system is also affected by delay, with some hospitals having no equipment, and there is always a long waiting period for the replacement of defunct machines.

In a Jamaica Observer exposé, the example is cited of a 70-year-old resident of St Catherine, name withheld, who in 2018, began experiencing severe pains in her left front abdomen and started navigating the health system in search of care.

For three years, the retiree, who has no insurance, was told by her doctors that they did not know what was wrong. The pain was intense, and her weeping and prayers were heard throughout the entire block where she resided in Greater Portmore, St Catherine.

Her daughter, a teacher, sought health insurance for the mother but found private options unaffordable. The daughter was also told that she could not place her mother on her own plan.

Finally, in 2021, the mother was diagnosed with stones in her gall bladder. Now she is awaiting a date for surgery, hoping to put together the funds for an operation in a private facility to bring an end to her chronic pain. She is also coping with diabetes and hypertension. Her daughter has taken several loans to assist her mother on her journey.

The case of this woman, battling chronic health conditions without health insurance, is far from isolated.

Low coverage

Everton Anderson, chief executive officer of the National Health Fund, on April 1, 2022, said that 21 per cent of the island’s population have health insurance coverage under its programmes.

Orville Johnson, executive director of the Insurance Association of Jamaica (IAJ) indicated that the estimate of the proportion of the population who have health insurance is approximately a quarter.

“This number includes dependents on health policies, such as spouses and children. We estimate that approximately a third of the workforce has health insurance coverage,” Johnson said.

The reasons for under insurance, Johnson said, are due primarily to affordability, lack of knowledge , accessibility, and there are those who are cynical about insurance.

“There are those who rely on the services at public health facilities as they see it as part of what the Government should do for them.”

Everton Anderson, NHF head, said that over 500,000 Jamaicans are enrolled in its programmes which subsidise the cost of drugs, but admitted that the list of conditions covered are restricted.

Programme benefits are applicable to people who meet the eligibility criteria, and have one or more of the chronic illnesses covered.

The number of people enrolled in the programmes as of February 2022 is 585,323. With Jamaica having a population of 2.73 million (Statistical Institute of Jamaica, 2019) this represents approximately 21 per cent of the population.

“High utilisation of the Drug Serv programme managed by National Health Fund, where approximately 720,000 Jamaicans receive medication for free, seek pharmaceutical care in the public sector annually, where medication provided on the Vital, Essential & Necessary (VEN) list is free.

“Not all drugs prescribed are covered by the NHF card. The condition diagnosed may not be one of the 17 illnesses covered by the NHF card, Anderson said.

Jamaicans with the NHF card automatically receive Jamaica Drugs for the Elderly Programme (JADEP) benefits upon reaching 60 years of age. The JADEP programme provides subsidies for 10 of the 17 conditions covered by the NHF card.

JADEP drug items are available at a minimal cost to the beneficiary – only $40 per item is paid to the pharmacy, and a maximum of $240 for six or more items.

Deepening subsidies

As to an expansion of the subsidy, Anderson said: “We believe the current subsidies offered are reasonable. However, we are always exploring ways to increase access and subsidy rates. Reviews are conducted periodically, with recommendations. The last subsidy increase was in 2017. Sustainability is a major consideration in increasing the subsidies. Any increase in subsidies must be maintained in the long run. The NHF will require additional revenue in order to increase subsidies and expand the benefits in a sustainable manner.”

Oliver Johnson, executive director of the IAJ suggested that the removal of General Consumption Tax (GCT) from health premiums would aid coverage expansion. “It would certainly help a start by taking GCT of health premiums and also exploring possible public-private partnerships. Some form of universal health coverage, which could be in the form of public-private partnerships for people, who cannot afford private coverage is needed.

“There are micro-insurance solutions marketed in Asia, Africa, and Latin America, where similar issues exist with health coverage. There is a solution called Hospital Cash, which is a simple, easy-to-understand health insurance solution. This could be explored when the micro-insurance legislation promised by the minister of finance is introduced. Besides this, affordability, access, and reluctance to purchase insurance still remains an issue.“