Universal Health Care: The Only Way Forward
HEALTH CARE IMPORTANT TO ME?
Today I want to focus on health care, more specifically, Universal Health Care.
Have you, for example, wondered why I am so preoccupied with the establishment
of a system of Universal Health Care in our country? Infact, why is health care
important to me?
I can answer these questions from a number of different perspectives but let me
start from a personal one. My family and I have been affected by serious,
indeed, life-threatening conditions. So much so that in fact for a number of
years some members of my family could not be here in Saint Lucia because the
necessary health services to care for one of my family members was not
available. Recently all of you will remember the situation with my wife,
Rose-Marie, who had to travel abroad for surgery to her spine.
I understand the desperate situation that many of you find yourselves. As a
fellow Saint Lucian I am moved to resolve this dilemma. Equally, as your leader
and Prime Minister, I feel the need to resolve the dilemma. From before you
elected me to office I was in discussion with health care workers encouraging
them to find the solutions to the health problems facing us. Access to necessary
health services has been a priority for me from that time. You may remember that
one of the first actions I took on assuming office in 1997 was to remove the
fees from Doctor’s visits at Health Centres.
I have been constantly agitating for the solutions including unrestricted access
to medications and comprehensive care programmes for persons with diabetes and
Health is important not just because of its value to each of us personally but
because, as economists have clearly shown, appropriate investment in Health
gives major returns for the national economy and is a fundamental pillar for
national development. Allow me, please, just as a reminder to quote from the SLP
manifesto of 1997, “The Contract of Faith”.
“We believe that access to efficient quality health is essential not only
because it provides a healthy workforce and improves our productive potential
but also, and perhaps more importantly because healthy individuals are more
likely to realise their full human potential”
THE FIRST STEP
Four months after I assumed office, the Cabinet formed the Health Sector Reform
Committee with the task of defining a way forward that would modernise our
health services and establish a system that would be able to find effective
solutions to the problems facing us. I wanted a health plan that would ensure
that the health services would be driven to continuously develop.
That was the first step. In December 2000, the Cabinet approved the Health
Sector Reform Policy entitled “Quality Services for Life”. The Cabinet at that
time charged the Ministry of Health, Human Services, Family Affairs and Gender
Relations to develop a plan to deliver the health reform.
In January 2002, the Cabinet of Ministers appointed the Task Force to examine
the feasibility of introducing Unemployment Insurance, Pension Plan for Farmers
and Fishers and National Health Insurance. This Task Force was chaired by the
Director of the NIC, Ms. Emma Hippolyte. In November 2003 the Cabinet approved
the Proposals contained in the NHI Task Force Report. In 2004, the Ministry of
Health, Human Services, Family Affairs and Gender Relations commenced the
development of the National Health Strategic Plan. European Union funds
supported a consultancy in 2005 to further aid in the development of this plan.
The Ministry is now ready to launch the National Strategic Plan 2006-2011, –
entitled “Quality Health Care for Life”.
This entire process has been a thoughtful and consultative one. Many experts
and, more importantly, people like you have contributed to the formation of this
plan. I need to thank all of you. The contribution of Saint Lucian people to the
Health Sector Reform Plan and the Universal Health Care Plan is what has made
these plans real and in touch with the needs of people like you. I need to
assure you that your work is not in vain because as leader you have now given me
a plan that I can deliver.
GUIDING PRINCIPLES OF UHC
The Health Sector Principles of equity, effectiveness and efficiency have
resulted in us adopting the strategies of social solidarity and universal access
to publicly guaranteed services. This simply translates into providing the right
health services at the right time to all people.
Throughout my life, I have been acutely aware of the high level of social
inequity and injustice in Saint Lucia. I have attacked inequity and injustice at
every opportunity. The Health Plan built on the value of social justice is
another strike that I will make against a system that has for decades developed
an entrenched discrimination and marginalisation of many vulnerable persons but
especially poor people. If you could see into my heart you would understand that
I do not want any Saint Lucian to be left behind, to be denied health care, to
be left to languish. I am distressed by the number of persons needing to raise
funds for necessary services by any means necessary.
I need to ensure that in the new system a forty year old, unemployed woman with
four children who discovers she has breast cancer can get all the appropriate
care without having to worry about how she can raise the money to afford any
component of her care including her radiotherapy.
I need to make sure that in a new system every person with diabetes is found and
is placed in proper care and receives proper treatment so that that person need
not suffer the devastation that that disease can wreak on his heart, his
kidneys, his eyes, his limbs, his brain, indeed his life.
I need to ensure that in the new system anyone with an emergency is met with
competent emergency service personnel, quickly and is rapidly and professionally
transported to well equipped and staffed emergency rooms in hospitals with full
support services and rapid access to proper care so that their lives and limbs
I need to ensure that every person with a mental illness is treated in a
comfortable environment conducive to recovery. I need to ensure that the patient
with mental illness receives the most modern treatment and gets all the
necessary support. I need to ensure that this person is treated with respect and
dignity as a fellow human being.
GUIDED BY PRINCIPLES
We have been guided by the basic principles that are embodied in the code of
Human Rights, the basic principles outlined as the foundation of all great
religions. Consider these words of Jesus Christ as captured by Matthew,
“Thou shalt love the Lord thy God with all thy heart, and with all thy soul and
with all thy mind. This is the first and great commandment. And the second is
like unto it, Thou shalt love thy neighbour as thyself. On these two
commandments hang all the law and the prophets”
These are the principles that form the core of our approach to Health. We fully
appreciate that sustainability demands careful planning and design to ensure
that the plan is feasible now and into the future. For this reason, I ensured
that much time was spent and many experts reviewed these proposals to design the
most practical system that can be true to the principles I hold dear. Let me
explain the system.
The Universal Health Care is a plan that gives access to health services at no
charge at the point of service. The services are not free because the money will
be raised through a special tax and from Government Revenues. These monies will
be placed in the UHC fund which will be managed by the NIC. This fund will be
completely separate for the other NIC funds. The UHC will have service
agreements with hospitals. These agreements will detail the expected services
and the necessary money to be paid from the UHC fund to deliver these services.
The hospitals will be paid a budget for the services agreed. The budget is
determined by the number of persons identified in the hospital catchment
population. The hospital is bound by the service agreements it has made with the
UHC to deliver all the services for this population at the standard detailed in
BACK TO NHI?
Despite this progress, all the carefully laid plans, Sir John Compton, Leader of
the UWP says, if elected, his party will go back to what he describes as the
National Health Service. Actually, I believe he meant the National Health
Insurance. According to him “we shall ensure that the National Health Service,
began eight years ago by the UWP Government, but abandoned by the SLP, is
inaugurated and managed and staffed by competent professionals and not by
persons appointed because of politics.” I leave the latter part of that
statement to your imagination.
Let us compare the UWPs’ NHI and the SLPs’ UHC.
WHAT IS THE DIFFERENCE BETWEEN NHI AND UHC?
The previously proposed National Health Insurance contained in the National
Health Insurance Act, No. 28 of 1996, was designed along the principles of
private insurance. It was a contribution system in which salary deductions were
to be taken and limited services were to be provided.
The services were divided into two main components—the Basic Hospitalisation
Plan and the Basic Non-Hospitalisation Plan. Benefits were to be restricted to a
maximum number of interventions per person per year and a financial limit was
placed on each intervention.
In the previously proposed NHI only contributors and their immediate families
would be entitled to benefits. The NHI was proposed to commence coverage of NIS
contributors and Government Employees and their dependents. Other persons namely
the self-employed persons, pensioners were to be considered in a later phase.
The indigent would remain a responsibility of the Central Government. The
unemployed were not going to be included.
Actuarial reviews suggested a 7% salary deduction although the UWP Government of
the day was considering commencing at 3%.
The UHC intends to cover all Saint Lucians from the onset. It will include the
elderly, the disabled, the indigent, the unemployed, the self employed, NIS
contributors, children and government workers.
The UHC will provide all necessary care to treat the diseases and health
conditions affecting Saint Lucians.
The UHC services were detailed before and include hospitalization for all
hospital services presently done in Saint Lucia. The UHC will provide medication
for all major conditions. The UHC includes all mental health services and
substance abuse rehabilitation services.
NO ONE OUT, NO ONE BEHIND
The UHC will include overseas care and special services for certain conditions
that cannot be treated in the general services. The UHC is intended to leave no
one out; we will leave no one behind. What is necessary for any of us is
necessary for all of us.
The UHC will be financed through a tax mechanism and not salary deduction. The
taxes proposed are on certain goods sold in St Lucia so that everyone will
contribute, but only in proportion to how much they consume.
The UHC is much more than a financing mechanism. It is a health development
fund. It is an insurance fund for the health infrastructure. It is a contingency
fund. It will also ensure that the quality of health care improves.
So, here you have it. The choices are before you.
Next week I shall share with you the services which will be included in the UHC
plan. So, until next week, God bless and have a wonderful Easter holiday. But
remember, please, do take care!.