Every month al­most $1 bil­lion is spent on health­care in T&T. The gov­ern­ment spends about half of that and pri­vate cit­i­zens, in­sur­ance com­pa­nies and the bur­geon­ing pri­vate health­care sec­tor spends the rest.

“We spend about $11 to $12 bil­lion on health an­nu­al­ly,” Dr Hen­ry Bai­ley, a lec­tur­er at the De­part­ment of Eco­nom­ics at the Uni­ver­si­ty of the West In­dies, St Au­gus­tine told the Busi­ness Guardian.

Ac­cord­ing to the lat­est da­ta from the World Bank, T&T spends about US$1,123 per per­son on health­care in this coun­try on an an­nu­al ba­sis.

We, there­fore, spend around US$12 more than the glob­al av­er­age of US$1,111. This glob­al av­er­age in­cludes the wealth­i­est and poor­est coun­tries.

To put it in­to per­spec­tive T&T spends 80 per cent more per per­son on health­care an­nu­al­ly than the US$621 av­er­age for the Eng­lish Speak­ing Caribbean.

“About half of the spend­ing on health­care in T&T is spent by the gov­ern­ment and the oth­er half is out of pock­et, it is pri­vate or through pri­vate in­sur­ance,” Bai­ley ex­plained.

He said peo­ple must re­alise that no gov­ern­ment can pro­vide all health­care for all of its cit­i­zens, a mis­con­cep­tion he has to cor­rect reg­u­lar­ly.

“If you ac­cept that no coun­try can pro­vide all health­care for all of its cit­i­zens then choic­es have to be made and there are some things that we are not go­ing to be able to do,” Bai­ley said.

“And this is why every coun­try in the world com­plains about this. Every coun­try in the world grap­ples with this prob­lem. There is al­ways so much that we can’t do for peo­ple be­cause health is like a bot­tom­less pit,” he ar­gued.

Bai­ley said there are a num­ber of peo­ple in the Unit­ed States who do not have any ac­cess, what­so­ev­er, to any health­care.

“It is pret­ty scary when you look at health­care and health out­comes in some of these de­vel­oped coun­tries,” he said.

And as such Bai­ley in­sist­ed the pri­vate sec­tor has a role to play.

“The oth­er mis­con­cep­tion that looms large for me is the idea that there is no room for prof­it or the pri­vate sec­tor in health­care. That is some­thing I come across all the time as well....The fact is that if there are some things that the pri­vate health­care sys­tem can do bet­ter and cheap­er than the gov­ern­ment then it might make sense for the gov­ern­ment to not pro­vide this di­rect­ly just out­source it to the pri­vate sec­tor and fund it, reg­u­late it and mon­i­tor it,” he said.

“If you can show that a pri­vate hos­pi­tal has bet­ter out­comes for open-heart surgery and can do open-heart surgery cheap­er than the gov­ern­ment and make a prof­it, then why not let the gov­ern­ment pro­vide through the pri­vate sec­tor,” he said.

Bai­ley said in this type of sit­u­a­tion it would be bet­ter for every­body in­clud­ing the pa­tient if the gov­ern­ment out­sourced to the pri­vate hos­pi­tal.

“We have had many of those arrange­ments in play and we still have many of those arrange­ments in play to­day and I think we need to be do­ing more of that,” he said.

“I do get peo­ple all the time say­ing that health is a fun­da­men­tal hu­man right and there is no way any­body should be mak­ing a prof­it on health­care and so on and so forth but I think there are many ways that we can bring the pri­vate sec­tor in­to health­care and cre­ate a win-win-win sit­u­a­tion for every­body,” Bai­ley told the Busi­ness Guardian.

To help an­swer the prob­lem of how to al­lo­cate the health sec­tor’s scarce re­sources is why the Health Eco­nom­ics Unit (HEU) was es­tab­lished in 1995, as one of the re­search clus­ters in the De­part­ment of Eco­nom­ics at The Uni­ver­si­ty of the West In­dies, St Au­gus­tine.

“The HEU staff is re­spon­si­ble for re­search, train­ing and project-re­lat­ed ac­tiv­i­ties in health eco­nom­ics and re­lat­ed ar­eas, in­clud­ing so­cial in­sur­ance, pover­ty, health and sus­tain­able de­vel­op­ment, eq­ui­ty, health pol­i­cy and man­age­ment. In 2008, the HEU was grant­ed the sta­tus of a se­mi-au­tonomous cen­tre with­in the Uni­ver­si­ty. Its name was sub­se­quent­ly changed to the HEU, Cen­tre for Health Eco­nom­ics to re­flect this change,” its web­site states.

“Health eco­nom­ics is re­al­ly the an­a­lyt­i­cal tools, the meth­ods of eco­nom­ics, the way of look­ing at prob­lems ap­plied to prob­lems in health­care,” Bai­ley said.

Bai­ley said ac­cord­ing to Mor­ris, De­vlin Parkin and Spencer (2012) health eco­nom­ics is de­fined as the ap­pli­ca­tion of eco­nom­ic the­o­ry, mod­els and em­pir­i­cal tech­niques to the analy­sis of de­ci­sion-mak­ing by in­di­vid­u­als, health care providers and gov­ern­ments with re­spect to health and health­care.

He said it has be­come a ma­jor branch of eco­nom­ics in the past 30 years.

“It is im­por­tant be­cause scarci­ty abounds in health­care,” Bai­ley said.

Bai­ley not­ed that what we do in health­care is cre­ate a de­mand for more health­care.

“If some­body in your of­fice col­laps­es with a heart at­tack to­day you can take them to Med­corp or Mt Hope or some­where where there is a Cath Lab, we will give them an an­gio­plas­ty and in a few weeks, they will be up and about again. But are they go­ing to live for­ev­er? And the an­swer is no. What we are do­ing is cre­at­ing to­mor­row’s pa­tient, that per­son if they con­tin­ue to live they are even­tu­al­ly go­ing to get can­cer or some oth­er very ex­pen­sive ill­ness and come back in­to the health sys­tem,” he said,

“The way this thing works is as we get bet­ter and bet­ter at treat­ing ill­ness, all we are do­ing is de­fer­ring the de­mand that these same peo­ple keep com­ing back in­to the sys­tem for more care,” Bai­ley said.

Bai­ley said some econ­o­mists point to the link be­tween the health of the pop­u­la­tion and the well-be­ing of the pop­u­la­tion and the amount of eco­nom­ic out­put.

“You can see us as a set of tech­nocrats whose job it is to sup­port pol­i­cy-mak­ers with tools to make de­ci­sions. We don’t ac­tu­al­ly make de­ci­sions. We don’t say ‘well open this hos­pi­tal or do that,’ but what we can do is we can do the math­e­mat­ics for you. And we can give you the tools that you can then use to make these de­ci­sions.”

When Fi­nance Min­is­ter Colm Im­bert pre­sent­ed this year’s $52.4 bil­lion na­tion­al Bud­get he al­lo­cat­ed $6.395 to health. Health’s al­lo­ca­tion this year was sec­ond on­ly to the $6.886 al­lo­cat­ed to ed­u­ca­tion.

Asked what he would do if he was giv­en the $6.395 bil­lion bud­get al­lo­ca­tion to im­prove health­care, Bai­ley said:

“I am not a pol­i­cy-mak­er and I recog­nise the Min­istry of Health is fac­ing a tremen­dous task to pro­vide health­care to this pop­u­la­tion with in­creas­ing fis­cal pres­sure.
Con­tin­ued on Page BG5

We are in the mid­dle of a pan­dem­ic and there is al­ways so much that does not get done,” he said.

“How­ev­er, if I were in charge of the bud­get, I would redi­rect some of the spend­ing that is not cur­rent­ly aimed di­rect­ly at pro­vid­ing health­care to build­ing ca­pac­i­ty in the eco­nom­ic analy­sis that un­der­pins (or should un­der­pin) de­ci­sion mak­ing.”

But how healthy is T&T’s pop­u­la­tion?

Bai­ley said the idea of mea­sur­ing how healthy a pop­u­la­tion is a rel­a­tive­ly new one and it is “ex­treme­ly prob­lem­at­ic.”

“The ide­al thing would be one num­ber that I can tell you that would have so much mean­ing as it would be re­al­ly use­ful if we had this, but it is prob­lem­at­ic be­cause health has so many di­men­sions,” he said.

Bai­ley told BG there are many in­dices that at­tempt to do this in­clud­ing us­ing life ex­pectan­cy, but they all have short­com­ings.

“The UNDP and oth­er or­gan­i­sa­tions give us our rank­ing vs oth­er coun­tries. We have mixed re­sults com­pared to oth­er coun­tries. We are nei­ther par­tic­u­lar­ly good nor par­tic­u­lar­ly bad,” he said.

“It’s like a pi­lot in an aero­plane that has many many di­als or many in­di­ca­tors telling him or her the sta­tus of many things and that is kind of where we are with this. So some­body with a point to make can pick and choose their in­di­ca­tors and cre­ate a sto­ry,” he said.

Bai­ley said when you look at life ex­pectan­cy in T&T the lat­est UNDP re­port puts us at about 73.5 which is high­er than the world av­er­age (72.8) but be­low the av­er­age for Latin Amer­i­ca (75.6).

“How do we in­ter­pret that? You need a lot more in­for­ma­tion to get a sense of healthy we are,” he said.

Bai­ley said when you look at the more spe­cif­ic mea­sures in the UNDP doc­u­ment we have made “great gains” on ma­ter­nal mor­tal­i­ty now down to 67 death per 100,000 live births.

“World­wide the fig­ure is 204 so we are way down com­pared to oth­er coun­tries but then Latin Amer­i­ca is al­so high­er than T&T. So how do we in­ter­pret that,” he said.

Bai­ley said around one in eight adults in T&T suf­fer from di­a­betes while glob­al­ly the fig­ure is clos­er to one in 12.

“So in that re­gard, we are not very well we have a long way to go,” he said.

In 2012 a study was done to de­ter­mine the health sta­tus of the pop­u­la­tion.

“Com­pared to oth­er coun­tries we are not sen­sa­tion­al­ly dif­fer­ent,” he said. The study is to be re­peat­ed next year.

Bai­ley al­so laud­ed Prof Karl Theodore for his decades work with health eco­nom­ics both in T&T and re­gion­al­ly.