The ‘free medical examinations’ – are we getting our money’s worth?

“ … they murmured as they took their fees,

There is no cure for this disease”.

Hilaire Belloc, Anglo-French writer, 1870-1953.

Our primary healthcare services are divided into two categories: a ‘free’ health service funded by our taxes, and a private ‘fee-for-service’ category, whose users are expected to pay for the services received. For those using the private service, the patient either pays out of pocket or co-pays with their medical insurance companies for the service. Some employers have medical insurance schemes for their employees, while some unions have negotiated deals that allow their union members an annual medical that the company pays for. So, there are many avenues for ‘free medical examinations’, mainly in the public sector but some in the private sector.

Against this background it is no surprise that our public health services are overwhelmed by hoards of people who descend on their doors seeking free medical care. The Ministry of Health recently opened a 24-hour service at two public clinics, offering more ‘free care’ to anyone or everyone with a national ID card.

This offer of free medical service does not seem to encourage people to stay healthy. Why not eat, drink and be merry? And if you get sick your fellow taxpayers would pay for your healthcare. Why exercise in this hot sun, when you can relax and take things ‘easy’? Only jealous persons would call this being lazy. Fast food and sweetened beverages both taste better and are competitively priced (and in many cases, cheaper) than their healthier alternatives. In 2017, the Government of Barbados introduced a tax on sweetened beverages: no problem, said the companies who sold beers. They promptly launched ‘4 for 10’ campaigns [4 beers for $10], so that these alcoholic beverages were suddenly cheaper than the sweetened beverages. And even now with the new sweetened beverage tax in place, pure bottled water costs slightly more than the sweetened beverages. All this suggests that it may even be cheaper to adopt an unhealthy lifestyle, and if ‘poor health’ results, then ‘free’ medical care awaits you.

So, is this ‘free medical care’ healthy or even cost effective for our country? Data from the Barbados Health of the Nation Study, a national epidemiological study which in 2015 looked at the health of 1, 234 adults aged 25 years and over, found that 66 per cent of these individuals were overweight or obese. This study showed that were so many people who had developed diabetes and/or hypertension that a majority of patients being treated for these diseases did not have their blood sugars and/or their blood pressures controlled. This means that, apart from costing taxpayers millions of dollars in medications, many patients still ended up at risk for disease complications.

How many persons develop complications? Barbados averages just over 30 heart attacks per month, and 20 people die from heart attacks each month. Another 20 die each month from strokes, on which roughly 45 new cases are diagnosed monthly. So many patients develop chronic kidney disease (CKD) that in 2017, taxpayers had to come up with BDS$19M to treat them. Other complications, including blindness, amputations and heart failure, decimate our working population. If it is suspected that you had a heart attack or a stroke, then it may be easier to get the ‘free’ MRI (Magnetic Resonance Imaging) test, ECGs (electrocardiograms) and blood tests, costing a couple thousand dollars in the Emergency Department, than it is to get a ‘free’ $5 tablet to prevent the heart attack or stroke in the first place.

It should be noted that recent calls for healthcare financial reform (including a series of town-hall meetings called by the Ministry of Health on this topic a couple of years ago) have focused on finding ways to fund more ‘free’ healthcare. The focus was on the quantity, rather than the quality of healthcare available here. And while some contributors to these debates pointed out that improving primary care, i.e. our health centers had the potential benefits of both improving national health (statistics) as well as reducing overall health costs, the official focus was directed to funding tertiary care, i.e. the Queen Elizabeth Hospital, so that tertiary care could ‘patch up’ all the clients that the under-resourced primary care could not serve adequately.

Our health services show little signs of being able to offer ‘Health Promotion and Disease Prevention’. Instead, the focus has shifted to providing emergency care to sick people, including reducing the stampede to the Accident & Emergency Department. So, instead of spending a few dollars to better stock our primary care facilities, we prefer to spend a few million to patch up those individuals whose disease we failed to try to prevent in the first place.

This ‘free medical care’ is actually very costly, in terms of limbs and lives. This ‘free’ care does not seem to encourage a majority of our population to adopt healthy life habits: the subliminal message seems to be ‘don’t worry, be happy’. If you get sick, the government will offer to ‘patch you up’ for free. It is hard to find anyone who will admit that we are getting our ‘bang for the buck’ with this free medical care.

To the ‘patient’ who relies on free care since the ‘free’ price cannot be beaten, our healthcare quality cannot be challenged: he/she just wants more ‘freeness’. This happens even when he loses his/her eyesight, kidneys, heart, brain or limbs. To the man signing over an ever increasing cheque to the Ministry of Health, in 2017 estimated to BDS$450M, health care is extremely expensive. Unless we move to change the trajectory of national health, we may be able to confirm that Hilaire Belloc was correct: there may be no cure for the illnesses in our healthcare.

Dr C.V. Alert MB BS, DM.

Family Physician.