Chief executive officer of the Queen Elizabeth Hospital (QEH), Dr Dexter James, has urged Barbados and its Caribbean neighbours to stop dodging the issue of health care financing.
Delivering the 22nd Annual Louis A. Lynch Memorial Lecture on Universal Health Care And Sustainability: Our Reality on Monday evening, James lamented the inertia displayed by regional governments on the critical issue, as he argued that too much was at stake to leave the matter unattended.
“The gains that the Caribbean has made in terms of immunization levels, good maternal and child health will be lost and eroded if we do not address this question of health care financing. It is no longer an option; it is really an imperative for us today,” he told a packed audience at the Grande Salle.
In the case of Barbados, James pointed out that resources made available to the island’s main medical facility were simply not enough to support the wide range of services it provided, and that strong policy decisions were urgently needed to fix the ever widening gap between demand and services.
“That gap is the challenge that most health systems will face. How do we narrow the gap so we minimize inequalities in the health system? Because the more this gaps opens, it means that more people will fall through the cracks, because you won’t have enough resources to satisfy demand for services. Something is going to give,” James warned.
The hospital CEO revealed that it cost about $15.8 million monthly to effectively manage and run the QEH. Of that, payroll accounts for $9.5 million, medical supplies $1.7 million, drugs $1.5 million, utilities $1 million, maintenance $450,000, and operating expenses $1.6 million.
“So we really need about $190 million to run the package [annually]. Currently we only receive about $154 million; so we are always short of funds to effectively sustain the current package that we provide.
“When we speak to economists outside, they say glibly, ‘Why don’t [you] cut back services?’ We say, ‘You make that choice for us; you tell us what services you would like us to cut and we will cut tomorrow. Stop dialysis for 241 patients, stop treating patients on lifesaving therapies, perhaps? Maybe close down the neonatal intensive care unit? You make the choice’,” James offered.
“In our context, the Barbadian population has come to enjoy this package of services; so it will be very difficult to talk about discontinuing services. This is not a supermarket that you could look at slow-moving items and then pull them off the shelves; you can’t do it because lives are at stake.”
The hospital administrator said the country needed to examine whether or not it should continue to mobilize financing through the taxation model.
“Has the shelf life of the taxation model outlived its usefulness? Is it time for us to now embrace a new model of health financing?” he queried.
James stressed that addressing the issue of health care financing was not merely about “fixing the QEH”, suggesting that remedies should first be applied to the delivery of health care at polyclinics.
“The fix of the health system is a system-wide fix of which the Queen Elizabeth Hospital is just one component. We need to make a further investment in our primary health care system.
“A polyclinic is the highest form of a primary medical facility that provides diagnostic services, and some that are sophisticated also provide minor surgery,” he pointed out. “None of our polyclinics have diagnostics. So a patient presents to the polyclinic with a non-urgent condition, but requires diagnostics. Where do they go?
To the Queen Elizabeth Hospital.
“These are the folks who remain there 12 and 18 hours –– 24 hours in some cases; and they complain bitterly. But, really and truly, they don’t belong there. That is not the setting of care for non-urgent cases; but the unfortunate reality is that these polyclinics do not have diagnostics.”
James insisted it was those types of issues that needed to be addressed immediately, as a new health care financing model was pursued.
“Because if we embrace the model that speaks to contributions by those who could afford, none of us would want to pay for the kind of inefficiencies that exist. So we have to fix those first and begin to give the population certain guarantees; so that you feel comfortable making your contribution to the health system,” he explained.
The hospital CEO was at pains to point out that universal health coverage spoke to prevention, promotion, treatment and rehabilitation.
He made a strong case for a system that created incentives for the hospital to become efficient, and for patients to take greater responsibility for their health.