No user fees!
Tread carefully on funding model for QEH, Govt told
With the Freundel Stuart administration said to be contemplating new health care financing options, a group of leading University of the West Indies (UWI) financial experts is warning that the introduction of user fees at this time, would amount to very bad medicine for those who depend on the state-run Queen Elizabeth Hospital (QEH) for treatment.
They further contend that user fees should not be the first remedy to soaring costs at the state-run health care institution.
Instead, they have suggested that the authorities zero in immediately on what they deem to be glaring inefficiencies at the island’s main hospital, as well as Government-operated polyclinics.
“I wholeheartedly disagree with the introduction of user fees and cost recovery,” said Terry Harris, an assistant lecturer in accounting, who was adamant that Barbados already had a system that results in cost recovery.
Therefore, he argued that a new payment scheme would simply amount to “more user fees”.
“We already have a system in place . . . it’s called taxes, and the Government is supposed to take our taxes and pay for health care, so the whole idea of user fees is a misnomer,” he said, while further insisting that “we are really debating the idea of more user fees at the hospital”.
However, Harris suggested that if Government opted to go this route, it should be a one-off payment and that users of the public health care system should not be made to pay repeatedly.
Lecturer in the Department of Economics Annette Greene also warned that while the QEH’s answer to its financial ills had been to ask for more money and other resources, the hospital needed to have a “properly working system”.
“. . . then you would know what you need to run it, [but] as it stands they don’t know,” she said, while pointing to a range of issues, including the use of Accident & Emergency Department (A&E) for “non emergency” cases.
“There is not enough space in the emergency room and we don’t have enough doctors. And from research that is not all. We have 20-odd people a day that don’t need to be there. If we assign a 100 dollars a day to those 20 people, it would cost the hospital less to build places for those people to go, than to continue to service them inside the hospital.” she said.
Former Opposition Barbados Labour Party Member of Parliament for St Philip South, Anthony Wood, also took part in last night’s panel discussion entitled, Paying for the Cost of Health Care in Barbados: the Great Dilemma, hosted by the Faculty of Social Sciences in the Department of Economics.
The discussion came just ahead of today’s heath care focus in parliament, which formed part of the week-long debate of the 2015/2016 Estimates of Revenue and Expenditure, in which an allocation of $150 million has been made for the QEH this year.
Wood, a lecturer in banking and finance, also voiced strong reservation about the introduction of a new payment system on the basis that too many families were experiencing hardships as a result of the economic downturn.
Arguing that a wealthier nation is a healthier nation, he said the onus must be on the Government to restore growth to the economy, which would lead to improvements at all levels.
“The benefits from restoring the economy to a structured growth path is that high levels of meaningful employment would indeed put people in a better position to take greater responsibility for meeting the costs of their health,” he said.
“Higher levels of economic performance would also mean that Government can also get higher levels of taxation so as to increase the allocation to play a more prominent role in the health care in Barbados.”
Lecturer in Finance and Accounting Stacey Estwick expressed the view that user fees should not be the first consideration, but she warned that citizens should make a contribution to their own health care.
She suggested that the Government considers implementation of a national health insurance plan.
“It might be something that we may able to combine with our National Insurance Scheme. I don’t think we want to go from scratch . . . Perhaps it is something we want to look at from the perspective of providing a basic package, looking at some of the major problems we have, diabetes etc. So I am not saying it is something that we would definitely implement now, it is something that we need to look at, because we should not be caught in this situation twice.”
Estwick also called for an audit of the processes and procedures at the QEH but was strongly opposed to the imposition of new taxes to fund health care.
However, Wood was of the view that there could be more strategic use of the current taxation system to derive maximum benefits.
“Individuals who are able to subscribe to meaningful insurances policies, that option could be facilitated through the taxation system and the Government provide some write off or opportunities for claim against their income tax for demonstrated spending on certain aspects of health care, including the health insurance claims,” he said.