Thompson

By the time this article is published the supplementary estimates would have been presented in Parliament. If the considerations contained herein are not factored in this supplementary, I urge and hope they will in the next.

The recent debate on heath care here in Jamaica was ended without a clear sign as to the next steps. We have been told by the head of the National Health Fund (NHF) that the fund faces collapse in another four years unless there is a major injection of funds. Added to that threat of a failed NHF is the Government policy of free health care. This policy, in effect, is a decision of not spreading the burden of providing a service across the user population - the insurance principle.

The Government's health care proposal, if reviewed in its entirety, is far more unworkable than we now accept. In addition to the 'free' care now being provided at hospitals, it is to be recalled that the governing party, while in Opposition, also promised state-of-the-art diagnostic centres across the country, owned and managed by the state. These diagnostic centres would be able to provide CT scans, MRIs and other advanced tests free of cost. It is time for a reality check. The country cannot afford free health care. This was the case before the recession and it is more so now.

Practical interpretation

The Government has abandoned the Liability Management Programme which essentially was a debt rescheduling plan. Carl Ross, in an article in Oppenheimer Magazine, published on September 8, debates the pros and cons of a restructuring of Jamaica's long-term debts, asserting that he is not of the view that the Government will and, if so, anytime soon.

A practical interpretation of this issue would suggest the Government has arguably defaulted on some of its debts, not through ill-will but due to hard times. In the face of this reality some promises deserve not to be kept.

But there is another level of complication in the country's expenses, in general, and the health budget in particular. There are alleged instances of lopsided payments wherein some health professionals are taking home salaries in excess of a million dollars per month.

Result of classification

This, we are told, is as a result of the classification of hospitals where the rates paid for sessional duty at Type C hospitals are two to three times higher than the rates paid at Types B and A hospitals. This issue has been dogging the health service for years and requires resolution.

There are a number of obvious imperatives I see:

(a) The Government needs to acknowledge that free health care is not affordable.

Repeal the current policy

(b) Having acknowledged this undeniable fact, the Government should repeal the current policy, which means abandoning the idea of state-of-the-art, state-run diagnostic facilities.

(c) The matter of alleged gross disparities in salaries to sectors of the health system needs to be addressed as a matter of urgency.

This last imperative, however, must be predicated on a broader premise. It is not only in the medical and para-medical profession that there are issues about wage disparities.

These exist elsewhere in the public sector and if there is going to be a sustainable correction to the problem and if the PM's pledge not to cut jobs is to hold (I doubt it will) then we have to look much wider. The distressing thing about the job cuts that are probable next year (based on the PM's word) is that it is lower-level jobs that will be cut, which will have a minor impact (if as strong as that) of the $118 billion wage bill. The approach cannot be cosmetic if the desired impact is to be realised.

Dr Canute Thompson is assistant vice-president at the International University of the Caribbean. He may be reached at canute_thompson@hotmail.com. Feedback may be sent to columns@gleanerjm.com.