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Whose Responsibility is it? # 22

The concept of healthcare and its real or perceived efficacy has been a challenge for developed and developing societies for a long time. For the very poor countries it does not exist except for humanitarian aid; and in remote indigenous societies they use natural tribal practices that have been handed down over thousands of years.

The developed and the developing countries have escalated a contentious attitude that has taken on wide ranging political debates, disagreements, and have grown to include the general population in these struggles that have toppled governments. Yet, an individual survey of politicians and citizens would probably find common ground on similar objectives, and short and long term goals with the mantra “affordable care for all”.

The developed and the developing countries have failed to accept that modern medicine has advanced at a much higher rate that their own economies have grown, and therefore they are unable to pay the costs associated with better but more expensive methods of diagnostics and treatment regimes. Even in the world’s richest nation the USA, “Obamacare” featured heavily in the Presidential race and debates.

The cost of dialysis was a major factor leading New York towards bankruptcy, as it was a lifesaving but expensive treatment, and prior to that invention we just died. It seems cold hearted to mention it in this way, but the reality is that before this development and successful organ transplants there were no viable life-extending treatments.

Modern communications has empowered a greater number of persons to investigate the latest treatments and even some cures, and many go to the doctor with questions based on what they have read. So expectations are high, and when patients and their loved ones are faced with “inadequate facilities” their anger factors rise and they find people on whom to vent their frustrations, usually politicians.

This would not have been so if those same politicians had held fast to a realistic script instead of the “promise the world” while on the hustings. But practicality and brutal honesty do not seem to be important job criteria for politicians worldwide. Feel good and unrealistic dreams seem to be their common fodder.

Coming back to Jamaica, our population is so closely connected to the Diaspora in North America and Britain, that the expectations of modern medicine are high from both sides.

Johnny in deep rural Jamaica calls his bredda in Nu Yaak and says “Jocko Mama well sick an har head no stap hurt har fi two weeks and she nah eat”. Jocko replies “mi a go send you some maney by WU timarrow and you take her hup to Pleasant Valley haspidal and mek she get a MRHi”.

This will not happen, and if Mama passes on Jocko will call the Consulate, write the newspapers, call the talk shows, and vent the grief; and he does not remember that these were the very conditions that made him choose to migrate in the first place. There has never been an ambulance or MRI in Pleasant Valley and perhaps there never will be, and the road to the nearest Type A hospital may be impassable.

Mama, Johnny, and Jocko, are merely victims of a system that promises much but fails to deliver. Words are nine day wonders, and most people choose to forget them and move along merrily until the disastrous reality comes to their homes. It is a scenario set up to accommodate wastefulness, incompetence, and fraud.

But healthcare does not have to be a part of this system. The promises to improve health services cannot be lost in “free healthcare” but at a very low standard. This cannot happen as long as Johnny and Jocko are in instant communication and are able to compare Jamaica with the first world. Improvements to human care cannot be subservient to the IMF dictates, and before we give in to inhumanity, something else has to give (like expensive office buildings for inefficient government departments, or retaining incompetent staff, or wasteful spending).

We can achieve targets without sacrificing health and education. The methodology is called non-partisanship, and in the immediate case of Cornwall Regional Hospital, Messrs. Tufton and Dalley have taken a good first step and I commend them. Illness is not a political disease and the treatment is medical not partisan, antibiotics not antagonism, surgery not chopping up one another.

Our instant case is the possible fallout that 16.5% GCT on health schemes may have, and some of the unanticipated outcomes; and some of these are:

  1. Companies may continue to pay increased premiums for employees as this is a next transaction (revenue neutral) that is passed on and may not affect corporate cash flows
  2. The company premiums cover the employees only (usually).
  3.  The extension to dependents is usually at the expense of the employee so they will pay 16.5% more than they currently pay.
  4. The employee may consider stopping family coverage leaving some members of their family exposed.
  5. If that is the case then Government hospitals (no fee paying) will likely see a surge of new patients in already overcrowded and poorly equipped facilities.
  6.  The self-employed person who has taken an individual or family plan will pay 16.5% more.

Deterioration in health must play a major factor in productivity, work and school attendance, thus affecting the future ambitions of 5 in 4, and the 2030 vision. We could be condemning ourselves to being sick and uneducated, and this is a recipe for poverty.

There must be other areas for containing costs or collecting from evaders who exist quite happily in the shadows of the informal and illegal economy. ( Oh dear there I go dreaming again for these are some of the very people who generously fund party campaigns. Silly me!)

We should be concerned as not all of our citizens can afford air ambulances, and First World hospitals, and if we fail to call for a policy that allows the improvement in the healthcare system then we are doomed.

 

Whose responsibility is it to set the conditions for the advancement of wellness for our population?

 

Executive Insights                                              
James Moss- Solomon
Executive in Residence
Mona School of Business and Management
March 15, 2017

 

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