Chronic lifestyle diseases, an ageing population, high patient expectations, and the political nature of healthcare have combined to place the Queen Elizabeth Hospital (QEH) in a no-win financial situation, a top hospital official said.
As QEH Chief Executive Officer Dr Dexter James explained, the best that management can hope for is to be able to narrow the distance between demands and needs for health services and whatever finances can be obtained through any public funding system.
The hospital has been plagued by financial problems over the years, with a budget and expenditure review from 2006 showing the institution experiencing a $25.9 million shortfall.
The situation worsened over the next several years, with the deficit reaching $34.4 million in 2013, before dropping to $19.7 million last year.
“It is the financing gap which poses a challenge to the Ministry of Health and the Ministry of Finance,” Dr James said while delivering a lecture on QEH financing.
Explaining that the demand for services and the cost continue to outstrip the availability of resources, he reasoned that no health services system could close the gap.
“We will always have this gap . . . the real challenge is what can we do to dampen demand in a way that narrows that gap,” he told those gathered at the Henry Fraser Lecture Theatre.
The difficulty in dampening that demand became clear when Dr James detailed “the drivers of demand and cost of services”. These include an expanding elderly population; a host of non-communicable diseases; inefficiencies in the healthcare system, particularly within the hospital; high public expectations around delivery of services; and a slow economy that was not keeping up with health care funding requirements.
The hospital executive gave as an example, a dramatic rise in the number of patients requiring haemo-dialysis, from three in 1979 to 275 today, with four to five new patients each month and an additional two to three on peritoneal dialysis per month.
“This is the new normal that is going to drive our healthcare costs if we don’t find a new model,” he said of the present dialysis care system that accounts for $15.9 million annually.
“Based on current growth rate this figure will move from $15 million to almost $25-$30 million,” he said of the five-year projection.
Dr James said other factors draining the hospital’s resources included the 25 per cent of Barbadians with at least one chronic disease – that number is targeted to grow to 33 per cent by 2025, he said – and the 14 heart attacks monthly, all linked to diabetes, hypertension, obesity with a requirement of an average nine-day stay for treatment consisting of diet, bed rest, nursing and medical services.
“The head of the Accident and Emergency Department would say there is a cohort of patients, we deem them like a revolving door. They discharge from the hospital, they go to eat all the pudding and souse and rum and whatever else they have to drink, and they come back into the Accident and Emergency Department, come to the ward . . . for nine days and back out again,” he said.
The health expert quoted statistics from the Barbados National Registry which show that Barbadians suffered 53 strokes per month, all linked to the non-communicable diseases; and that a recent study on the use of 261 beds in the 600-bed institution found that 42.5 per cent of patients were diabetic; 89 per cent of admissions were linked to the diabetic foot. “These patients remain nine days at the Queen Elizabeth Hospital. Meanwhile the Accident and Emergency Department is bursting at its seams, can’t get any beds to bring patients onto the wards because these beds are occupied by very sick patients whose diabetic conditions have gone out of control.
“These are the drivers of cost, and the new normal within our public health system,” he explained.
Dr James said that managers of the island’s main medical facility often butt heads with economists in meetings, “because the first question posed to us is what services can we cut?”
He said that the economists’ approach to the QEH problems was the same as dealing with a supermarket operation, “where you could look on the shelves and see slow-moving items, high-priced items, remove them and say, ‘let’s discontinue this line’.
“What do we discontinue: stop dialysing 2,000 patients and then save $18 million; patients on life-saving therapies, do we stop treating them?”
Dr James said Barbadians had grown used to a certain breadth and depth of services and it would be difficult and political suicide to attempt to discontinue these services.