Last Friday, the Ministry of Health staged a conference at the Lloyd Erskine Sandiford Centre on the topic Achieving Sustainable Health Care Financing, and invited me to attend and share my views. Unfortunately, I was unable to attend this very important confab, but I was able to contribute a document that contained four of my core ideas on this issue, particularly as it relates to the Queen Elizabeth Hospital.
This is a matter which I addressed some time ago in this column, and in light of this new initiative by the Ministry of Health, I embrace the opportunity to reiterate the following proposed solutions:
1. A voluntary citizens’ funding mechanism. I believe that there are literally tens of thousands of citizens and residents of Barbados who would voluntarily make financial donations to the QEH as their preferred “charity of choice”, if a mechanism existed to make such giving easy, convenient and stress-free.
I have therefore suggested to the Bankers Association of Barbados, the Barbados Co-operative Credit Union League, and the QEH board that a national programme should be put in place whereby citizens and residents who already possess accounts at the six retail banks and the five major credit unions of Barbados could be encouraged to determine upon a charity of their choice –– the QEH –– and to execute a standing order authorizing the officers of their bank or credit union to transfer a monthly sum –– with $10 being the monthly minimum –– from their bank or credit union account to an account that the charitable organization (QEH) would establish at each of the six banks and five major credit unions.
Barbadians should be encouraged to engage in philanthropic giving, and those of us who could afford it should be inclined to make the QEH our charity of choice and to sign a standing order to give $10, $20, $50 or $100 per month (whatever we can calmly afford), and not feel that we have taken any undue burden upon ourselves.
I put this proposal to the Bankers Association and the Credit Union League back in January, 2014, and to the QEH in June, 2014. I hereby put forward this proposal again.
2. The National Insurance Scheme to the rescue. Whilst the Government and taxpayers of Barbados will always have to subsidize a majority of the operating expenses of the QEH, the National Insurance Scheme could be utilized to underwrite a significant portion of these expenses!
I propose that we modify the currently existing National Insurance Scheme, and establish a new component of it, under which we set aside part of each contributor’s monthly National Insurance payment for a part-coverage of the cost of any medical treatment that such contributor or their immediate family members receive at the QEH.
In other words, let the National Insurance Department set up a special medical services account into which a suitable percentage of each contributor’s monthly NIS submission is paid –– say five per cent of contributions. These funds will then be called upon to help finance a stipulated portion of the expenses associated with treatment at the QEH of the contributor or the members of his or her immediate family: spouse, children, parents or grandparents.
These NIS funds would provide the QEH with a steady and reliable stream of income which, in tandem with Government’s annual financial allocation, should be sufficient to cover the recurrent operating costs of the hospital. (This initiative will also provide an additional incentive for all employed andself-employed Barbadians to sign up and contribute to the NIS!)
3. Reform the management structure of the QEH. The QEH is the largest and most complex institution in Barbados, employing some 2,500 workers and carrying out some of the most technical and complicated medical procedures imaginable. Such an organization cannot be adequately managed by a group of part-time directors who are not intimately involved with the complicated workings and procedures of the hospital on a daily basis.
In spite of this reality, the currently existing Queen Elizabeth Hospital Act stipulates that “members of staff of the hospital shall not be appointed as members of the board”.
This is sheer nonsense! The act should be immediately amended to provide for a board of management comprised of the chief executive officer of the hospital, the senior medical, engineering and administrative officers, and representatives of the junior doctors and ordinary hospital workers.
Such a board of directors would be possessed of the specialized knowledge and information on which the hospital operates, and would therefore be well positioned to engage in the complicated decision making that is necessary.
Such a technical board of management could then be held accountable by a board of public trustees whose function would not be technical management or decision making, but rather ensuring there is no corruption or nepotism at the institution and that high ethical standards and a code of ethics are maintained.
4. Collaboration with the Cuban health care system. My fourth and final suggestion is that the Barbados health care authorities (inclusive of the management of the QEH) make use of Barbados’ enviable relationship with the Republic of Cuba, and collaborate with the Cuban authorities in programmes designed to improve the quality of health care
The Cubans, for example, have developed a system in which a patient does not wait longer than half an hour
in the Accident & Emergency Department before receiving medical attention.
Cuba has developed a system of preventative community-based health care, at the centre of which are medical doctors who are assigned to a specific number of households in a community.
Cuba has also made tremendous advancement in the manufacture of pharmaceuticals, including new cutting-edge drugs to deal with the ravages of such chronic non-communicable diseases as diabetes. The Cuban government, I am sure, would be more than happy to collaborate with our Ministry of Health and our QEH in sharing the benefits of the Cuban health care success story with us.
All that is required of us is that we make the necessary proposal or request to Cuba.
(David A. Comissiong, attorney-at-law,is president of the Clement Payne Movement.)