User Fees Major Impediment to Poor Accessing Health Care- Spencer

Minister of Health and Environment, Rudyard Spencer, on Tuesday (March 3) defended the Government’s decision to abolish user fees across the health sector, noting that the user fee structure was “regressive” and a “major impediment” to some persons, particularly the poor, accessing health care.
“The Jamaica Survey of Living Conditions 2007 shows that 50.8 per cent of the poorest quintile, who reported an illness, did not seek health care as they could not afford to do so,” the Minister stated at a media briefing at his downtown Kingston office.
Additionally, he said, the evidence indicates that user fees “have increased poverty, because they reduce the disposable incomes of the poor and deplete their asset base.resulting in “deteriorating health outcomes, increasing morbidity, and reduced life expectancy.”
“By abolishing user fees, we have put back almost $1billion in poor people’s pockets that could not afford it,” he added.
A Task Force, which was established in October 2007 to review the operations of the Regional Health Authorities (RHAs), had recommended that user fees only be abolished at clinics, but retained at hospitals, with an “appropriate, sensitive system for exempting the indigent.”
Minister Spencer said that the Government opted against the proposal because there was inadequate evidence to suggest that restricting the abolition of fees to clinics, would have yielded a response, similar to what currently obtains with universal removal.
The Task Force had also suggested that the removal of fees should be done incrementally and Minister Spencer said that “indeed, we were going to go that way, but when we examined (the situation), we saw that we could afford it, because it would cost us only 12 per cent more, so we went all the way.”
He indicated that Government chose to use the policy, implemented in April 1, 2008, as the platform to put in place the necessary reforms to the primary health care system, with technical assistance from the Pan American Health Organization.
According to the Health Minister a “vast number of people are now seeking health care,” since the abolition of user fees.
Citing statistics, he said that the number of visits to clinics have increased from 35 per cent over a one year period from April 1, 2007, to 69.9 per cent between April and September 2008. “That, by itself, justifies that it makes sense to abolish the fees,” he stated, noting that prior to the abolition, only 12 per cent of chargeable fees were being collected.
In addition, 86 per cent of persons currently accessing the service since the abolition have expressed satisfaction with service delivery.
In the meantime, Mr. Spencer said that restructuring and transformation of the health sector has commenced with activities at the Ministry’s corporate office. He explained that the new structure at the office “reflects a recentralization of some functions,” such as human resource and project management. The new structure also reflects a strengthening of the Ministry’s monitoring role in holding the RHAs more accountable, as well as a more direct reporting relationship between the regional directors, the permanent secretary, technical directors, and chief medical officers.
Regarding the legality of RHAs, Mr. Spencer, explained that “these schemes of management were established, based on an Act of Parliament.”
“The RHAs, like executive agencies, are schemes of management designed to delineate between policy and service delivery functions,” the Health Minister added.