Complaints about the health system seem to be increasing every day. Tearful stories are emanating from the daily experience at all of the country's hospitals. Good reports are few and far between. Complaints cover long waits for critical surgery, inability to see doctors, lack of medical skills, unavailability of drugs, non-functioning equipment, shortage of surgical materials, medical incompetence, shortage of beds, rude and unsympathetic nurses,etc. The list can go on and on.
The disenchantment is turning to anger in the face of inadequate responses and failure to deal with simple problems. Maladministration provides only part of the explanation. The whole health structure and the underlying philosophy are in need of revamping given the increasingly complex demands being made of the system. There is a skills and training deficit in almost every area. Some people should not be working in a hospital.
Over the last few weeks I had reason to visit the Mount Hope Hospital on a regular basis, mainly to observe the progress of the Wallerfield racing accident victims.
I wondered what the future held for these young people who looked like they came from a war zone in Syria. As I reviewed the videos of the accident, I also wondered how could a group of people in their right minds contrive such a death trap as a centre for amusement. I also wondered how could officialdom sanction a complex masquerading as a theatre for entertainment and yet be so fundamentally deficient in basic safety measures. Who is responsible for the public's safety? The answers must come. We have a ringside seat to see how public decisions are made.
Mount Hope was intended to be a high-tech efficiently-functioning institution. My interaction with doctors, nurses, support staff and patients tells me that many of the complaints are well founded. Don't get me wrong. There are some dedicated personnel who work under difficult circumstances, and in unguarded moments will tell you about the unprofessional environment, the endemic indiscipline, the lack of common courtesy and the absence of management systems.
In one ward not a single fan was working. Call buttons which patients use to summon help were not functioning. The adjustment systems in many beds seemed to have died. For heaven's sake, these things are not difficult to fix. The shortage of drugs and materials may be related to the untimely release of funds, but where is the maintenance capacity? Who appoints the hospital manager?
The Minister of Health has to take responsibility for overall governance but doesn't have to run the hospital on a daily basis. Does anybody ever get fired for non performance? I am told yes, but it is the hardworking competent ones who are given the boot, particularly if they are foreign. It is easy to understand why institutions, like countries, fail. Nobody is responsible for anything.
People pay taxes in return for certain public services. Many who pay taxes still prefer to go to private institutions because of the poor quality of public health care, or because the service they require is not available in the public hospitals for one reason or another.
Private insurance arrangements have saved the lives of many. But not every one can afford them. Lower income people, retirees and pensioners depend heavily on the highly-subsidised public health care system because they can't afford private facilities. They take what they get and complain.
The growing population is putting increasing pressure on a creaking and demoralised system. But it is not only the population; it is the level of crime, poor health lifestyle, accidents and a range of other factors.
Over the years, all governments in this country have invested heavily in education and health. The annual financial allocation to health as a proportion of GDP compares well with most middle income developing countries. The question to be answered is why has the return not been forthcoming. We probably get back about 25 to 50 per cent of each dollar spent.
It is not how much we spend but the effectiveness of the spending that counts. We have developed the unsavoury habit of throwing good money after problems instead of dealing with causes. It does not make sense giving up scarce resources for services that are not forthcoming.
In a real sense the so-called "free" health service is a myth. Given the amount of money being spent on training, why is the country so depleted of trained people in many fields? Why is it you can't get an ambulance when you need one? Why are family members given a list of items to purchase when a member is admitted to the hospital? Why are so many special-needs children always in the public eye seeking assistance? There is clearly a need for a fundamental intervention. I will address one approach for relieving the growing chaos in the health system.
I am suggesting here the establishment of a national health insurance plan (NHIP) which is not a new nor original idea. There are different models with different kinds of controls and accommodations. We should have had one in place since independence. Instead, efforts were made to patch up a dysfunctional system completely dependent on central government finance and bureaucrats with little experience in running a hospital.
The NHIP would be a contributory plan drawing on the resources of both participants and the government. The present Health Surcharge has no direct relationship to health care. Special arrangements can be made for the poor and indigent. The contribution to the plan can be made tax deductible.
The NHIP would remove the pressure on the present health care system which can be remodelled to cater for a smaller number. Participants would be free to choose their hospitals and their doctors, and acquire such drugs and services that they need with reimbursement coming from the plan.
This arrangement would obviate the need to go to a public hospital and sit on a hard bench for a whole day, or wait two years for an appointment for a simple operation which may never materialise. This plan would remove the humiliation human beings now undergo on a daily basis.
Those who see this innovation as simply a new tax probably have no idea about the cost of private health care. A cataract surgery, for instance, could cost $15,000. Brain or heart surgery could take you over $100,000.
This so-called free system we have inherited is fast breaking down. CDAP was well intentioned, but questions surrounding the quality of many of the drugs, financial problems and the unreliability of supplies have undermined the programme.
Pensions are not being used to buy food. Lifesaving drugs are the first call, and the price of drugs and imported food are increasing everyday with the depreciation of the exchange rate. The clinics of all eye doctors are filled on a daily basis. This is only one aspect of the supply/demand equation.
It seems we not only need a hospital for children, we need one for old and handicapped people as well–people who have given their life for the development of the country. The problem of development is a problem of efficient resource use.
Ramesh F Ramsaran
Professor Emeritus