Defying current tight economic circumstances countries like Barbados should move towards providing universal health care because the social benefits could spur economic growth, but restricted access to medical care may further retard development, says the Pan American Health Organisation’s Director Dr Carissa Etienne.
Caribbean countries have formally agreed to provide universal health coverage, in which medicines, treatment, care and prevention services are prepaid by all citizens, usually through a public health insurance system which is accessible through both private and public health care providers.
“Health reform, or health systems transformation, is achievable by setting the goal of universality, equity and the right to health. It is achievable even when a country faces economic crisis,” Dr Etienne said as she delivered the 43rd Sir Winston Scott Memorial Lecture Monday evening at the Frank Collymore Hall.
The Dominican physician contended that on the contrary, “out of pocket expenses, particularly the payment at point of service, user fees, is the most effective barrier for access to health services”.
Defining health care reform as substantive changes to health with the ultimate goal of better meeting the needs of the population, she said it is not about just bricks and mortars of clinics and hospitals, but as the World Health Organization states, “all organizations, people and actions whose primary intent is to promote, restore or maintain health.
“Health reforms will not be possible without more and better financing for health. Investing in health systems that are equitable and efficient, including interventions to reduce segmentation is important,” Dr Etienne said. “The benchmark for public financing of health has been set at six per cent of GDP.”
The matter of healthcare financing drew questions from Central Bank of Barbados employees: Communications Officer, Novaline Brewster, who queried how could this be done amid low economic growth; and Bank Secretary Elson Gaskin, who wondered about raising money through a lottery.
“It’s called political will,” was the second-term PAHO Director’s response to Brewster. “The government must make a decision as to whether it will provide health care for all of its people”.
She argued that many countries have faced economic crises but continued funding health care because “when you face an economic crisis, people lose jobs so they are unable to pay the fee for service. They are unable to keep up with their health insurances and they are more likely to become ill. So this is not the time to reduce the access to health services for your people”.
Hesitant to delve in the intricacies of economics, the surgeon made passing reference to the concept of ‘counter cyclical spending’ in which many countries in Europe and elsewhere have boosted their economies by investing in health.
Besides the pure economics gain, she cited the example of Thailand that in the 1980s went against the World Bank’s advice to cut spending on universal health coverage because the economy could not afford it. She said this caused a number of institutions to turn their backs on the Southeast Asian country’s reforms.
But within 20 years that country reportedly has a successful healthcare system covering most of its population for a flat individual fee of 30 Baht (estimated 91 cents US) with exemptions for children, elderly and impoverished.
On the issue of raising health care money through a national game of chance, Dr Etienne said, “unless you have moral issues about a lottery there is nothing wrong with doing a lottery to raise finance, as long as those finances are going to be ploughed back into health”.
She said finances could be raised through introduction of higher sin taxes but, here again, the money must go directly to health care, not the treasury.
“You can tax alcohol and tobacco and sugary beverages but government must make that decision not to put those monies into the Consolidated Fund but to ensure that those resources are re-invested in health, particularly in promotion and prevention of diseases.
“It is for a government and its people to decide what are some of the innovative ways they are going to utilize to increase finances and resources for health,” the hemispheric health care chief said. (GA)