Even though successive governments have pumped billions of dollars into health care expenditure over the years, many Barbadians complain about poor health services, while others are paying too much.
These opinions were offered by a number of health care-related professionals, including Director of the National Insurance Scheme, Ian Carrington, and Health Planner in the Ministry of Health, Danny Gill, during a recent panel discussion that examined the prospects and relevance of efficient universal health care in Barbados.
“We spent [$733] million on health care of which 55 per cent is derived from Government revenues,” Carrington said, reflecting on figures produced by a study of the years 2012 and 2013. “That is sufficient to take care of the health care needs of the Barbadian population, even though I recognize that we have an aging population and a population suffering from significant non-communicable diseases.”
He added, however, that what has to be considered is, “how do we construct a framework for the delivery of health care utilizing that resource base that is most efficient so that all Barbadians will receive a basic minimum standard of health care”.
The discussion led off a Queen Elizabeth Hospital-sponsored symposium on Universal Health Coverage: A Privilege or a Right. It involved a team of health care administrators and practitioners along with a social activist and an economist.
It was the fourth such event organized by the QEH and took place against the backdrop of what some describe as a crumbling health care system. The panellists all agreed there is need for change in the way services are delivered and received.
“If we allocate our resources in the best possible way, we can pull all of humanity up to a certain standard,” Carrington said. He added: “The question is how do we as a community utilize our scarce resources to ensure that there is a basic minimum standard of health care for all.”
The research findings, which formed part of a Ministry of Health discussion paper on health care financing, found that “Total Health Expenditure (THE) in Barbados in 2012-13 was $732,703,759, of which 98 per cent represented recurring spending i.e. spending on health goods and services that were consumed within the year of the Health Accounts analysis.”
“The remainder of spending was for capital investment (spending on goods and services whose benefits are consumed over more than one year) and care related items such as social care for HIV. This THE represented 8.7 per cent of Barbados’ gross domestic product,” the report stated, adding: “Also, this expenditure was equivalent to $2,582 per capita. Compared to the rest of the Caribbean, Barbados’ per capita health expenditure ranked the third highest in the Caribbean behind the British Virgin Islands and the Bahamas.”
Gill, who as the Ministry of Health’s Director of Planning and Research had a hand in the study, said that out of that $733 million annual average health care expenditure, “39 per cent comes from out of pocket [of individual Barbadians]”. He explained: “There is a rate set by the World Health Organization for out of pocket payments for health. It is 20 per cent. It means we are 19 per cent above what it should be”.
He argued that if Barbados is to maintain the current spending figure and rate, “you would still be unfairing people who are taking more [out of their pocket]. “In fact what has happened in Barbados is that there are persons who are going into debt to finance health care,” he added. “Universal health care coverage speaks to providing the care in such a way that everyone can access it and having those funds to provide that care. Right now we’re not doing it in Barbados.”
Gill said that based on the argument of the policy paper, “we’re saying to government we need to go towards a national health insurance scheme. Basically that would change the way in which we finance health”.
Gill’s position appeared to be that the money allocation to various aspects of health care should be shifted for more effective use. He spoke of increased life expectancy, decreases in infant mortality and maternal mortality, and reductions in communicable diseases as health gains.
But pointing to new burdens, he added, “we’ve done it so well that now we’ve gone over and we’ve grabbed on to the NCDs (non-communicable diseases) and we’re not letting go”. “Fifty per cent of the budget for the Barbados Drug Service goes to finance drugs for NCDs,” he said.
Opening the discussion, QEH Chief Executive Officer, Dr Dexter James, spoke of the NCD financial load. “Today 25 per cent of our population has at least one NCD and (it) is expected to go to 33 per cent by the year 2025,” he said. “Chronic diseases have gone to a stage of almost epidemic proportions,” Dr James added, quoting Barbados National Registry data for 2013 showing there are 14 heart attacks and 53 strokes per month, all related to NCDs.
Gill, the coordinator of the Strategic Plan for Barbados 2002 – 2012, warned: “If we go with the same system where we’re putting new wine into old bottles in terms of how we pay for our services, we will have a problem”.