Thursday, March 16, 2017

MAJ comments on Health Insurance Tax

March 16, 2017
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Dr Myrton Smith
President, Medical Association of Jamaica

Universal Health Care is a concept that forms an important part of any nation's push towards prosperity. The removal of any impediment to the average citizen's access to health care is vital. It is a goal that is endorsed by the World Health Organization. Jamaica recognized this and in 2008, user fees were completely removed in all public health facilities (except the University Hospital of the West Indies). 
While we endorse the concept, we recognize our limitations in terms of our ability as a nation to afford 'free health care" for everyone. With less than 4% of GDP spent annually on the health sector, the financing of healthcare in Jamaica remains suboptimal. 
One strategy utilized by many countries is to have national health insurance schemes that force persons to contribute to a health insurance policy when they are well, so that when they are ill, they can be taken care of. Jamaica currently has no such national health insurance scheme. It was an important part of the manifesto of the current government that such a plan would be launched. Not much has been heard recently about the status of the plans for this scheme.
Private health insurance, either through group or individual policies, represents an important​ means of allowing persons to have access to quality health care. It is estimated that currently only around 25 – 30% of Jamaicans have private health insurance. We are concerned that the government's move to apply GCT to health insurance premiums will drive up the cost of insurance, with the risk that many persons will be unable to afford it. Alternatively, persons may have to review and revise their coverage options and become underinsured. 
We anticipate that more persons will flock to the already overburdened public healthcare facilities. The thought that employers will volunteer to bear the costs related to the payment of GCT is at best erroneous and at worst disingenuous. The government as a major employer and a large purchaser of group health insurance has a track record of passing on increases in premiums on to the employees. This is what they have done over the years to the medical doctors. Why then would we expect that the government will behave differently with this new tax or that other employers would be any more willing to absorb the cost.
We are particularly concerned about the impact that this will have on the management of major killers such as non-communicable diseases like cancer. Cancer treatment in the public sector is woefully suboptimal with recurrent shortages in chemotherapy drugs and long waiting times for access to outmoded radiotherapy. It is often private health insurance that allows many persons to access chemotherapy and radiotherapy in the private sector. What will happen to those who are forced to opt out of health insurance? 
We still await the promised introduction of the linear accelerators at St. Josephs' Hospital and the troubled Cornwall Regional Hospital, both of which should have been operational by February of 2017. 
With the introduction of additional financial burdens on Jamaicans in need of health care, it is a good time for the government to unveil how they plan to improve the delivery of health care to all Jamaicans. There is the need to fast track changes that will make a positive impact.
Dr. Myrton Smith
Medical Association of Jamaica

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