Where does individual responsibility lie in the universal health care coverage system that is favoured for Barbados, and how do public health care facilities react to persons whose negligence creates a greater demand on medical resources?
A system of universal health care coverage speaks to funding from a common source, usually taxes, for all the population but a recent discussion on the medical care options facing Barbados, saw a number of participants asking how should costs and charges – if any- be applied to those who do not take basic measures to stave off preventable illnesses.
The reasoning behind such a query is that it may be unfair to other taxpayers who live healthily to carry the burden of others who disregard prevention advice and indulge in unhealthy practices that eventually lead to illnesses which are costly to treat.
“Where is personal responsibility in that matrix?,” asked Queen Elizabeth Hospital CEO, Dr Dexter James.
Continuing, he queried, “Is it right for you to knowingly have a particular disease condition, do not manage your particular condition and you present to the public health system and expect care to be provided, unfettered?”
“The protection of one’s right to care is inextricably linked to this whole question of personal responsibility,” he argued.
Dr James raised those points during discussions at the QEH’s Fourth Annual Healthcare Financing Symposium, held last month in the Henry Fraser Lecture Theatre of the University of the West Indies, Cave Hill Campus.
The theme of that discussion forum was Universal Health Coverage: A privilege of Right.
Examining that ‘right’, one of the discussion panelists, NIS Director Ian Carrington, gave a theoretically case. “So I am a chronic alcoholic. I have basically drank myself into a state where my kidneys and my liver are destroyed and therefore am I entitled to a kidney and liver transplant?”
There was a suggestion from a member of the audience that there should perhaps be a demerit points system for ‘repeat offenders’ who turn up at public medical centres with the same preventable illness a number of times, and others with preventable diseases.
Responding to that suggestion with the aim of widening consideration of the dilemma of universal health care, Dr Reginald King asked, “would you deny care to someone with lung cancer because they smoked? Would you charge somebody for having HIV because they had unprotected sex?”
These are the real issues and considerations that Barbados faces as it seeks to revamp the current broken health care system and use the pool of available money for more efficient provision of medical care.
A 2015 Ministry of Health study showed that Barbados averages $733 million per year on health care spending.
Another panelist, the Health Ministry’s Director of Planning Danny Gill noted, “out of that $733 million, 39 per cent comes out of pocket. There is a rate set by the World Health Organization for out of pocket payments. It is 20 per cent. It means that we’re 19 per cent above what it should be”.
That 19 per cent above the universally accepted portion of personal payment for a population carries dire realities for people in Barbados, as Gill noted, “there are persons who are going into debt to finance health care”.
Gill sees universal health care as a system of giving access to all and having the money to provide it, but he pointed to an area of financial drain where those who ignore advice on preventative health practices may be lingering.
“Fifty per cent of the budget for the Barbados Drug Service goes to finance drugs for non-communicable diseases,” he said, adding that overall a lot of the health care dollars goes towards curative intervention and not prevention.
But NIS’ Ian Carrington insists that while Bajans ponder on these troubling issues that lie within the concept of universal health care suited for a developing country such as Barbados, provision of medical attention to all remains the way to go.
“Avoiding those questions does not eliminate the fact that if we allocate our resources in the best possible way, we can pull all of humanity up to a certain minimum standard,” he said and pointed to the United Nations Human Rights Declaration that places Social Security as Human Right Number 17, and health care is a sub-set of social security.