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.
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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.