Al Edwards, Financial Editor 
JUNIOR DOWIE/STAFF PHOTOGRAPHER: Ryland Campbell, chairman of Capital and Credit Merchant Bank and the National Health Fund, addresses the 40th anniversary luncheon of the Lions Club of Kingston at the Jamaica Pegasus Hotel.
JAMAICA'S HEALTH financing policy and administrative system should not be fragmentalised and should be brought under one roof. So said the chairman of the National Health Fund (NHF) Mr. Ryland Campbell.
Speaking on Wednesday as the special guest of the 40th anniversary luncheon of the Lions Club of Kingston at the Pegasus Hotel, he said: "I make bold to say it is costly to the country to have a fragmentalised health financing policy and administrative system. There must be an urgency to rationalisation. There is absolutely no need for health financing in CHASE, health financing under the NHF. Call it whatever. An effort should be made to return the health budget to 10 per cent of the national budget.
Despite the lack of resources Jamaica has made significant strides in health care in relation to its population size. The 2003 PAHO Report on basic indicators shows that in Jamaica life expectancy at birth is 75.9 years. Now this compares favourably with both the United States and Barbados at 77.3 years and Canada at 79.5. Jamaica's main rival in the region, Trinidad has a life expectancy at birth of 71.1 years.
DEGREE OF COMPLACENCY
What is remarkable is that Jamaica has been able to achieve these gains with a low per capita expenditure on healthcare. The WHO in its analysis of the
performance of health systems ranked Jamaica as eighth in the worlds in terms of its efficiency in securing health gains at a
relatively low cost.
Mr. Campbell noted that though this is commendable from a cost analysis perspective there is still a degree of complacency about health care both at the individual and institutional level in Jamaica. He pointed to the average per capita expenditure on health care in Jamaica is US$158 while in the United States it stands at US$4187.
"The majority of Jamaicans are taking care of their health care costs out of their own pockets. The high costs associated with providing good quality health care makes it very burdensome for individuals and families who must pay for the services. Only approximately 12-14 per cent of the Jamaican population has health insurance. The survey of living conditions shows that, during the period 1989-2001, household out-of-pocket expenditure on health care increased at an average rate of 12 per cent per annum of which expenditure on drugs increased at 15 per cent per annum."
"Government has a role to play in ensuring equitable access to health care for all. However, the amount spent on the provision of healthcare through the budget has been declining over the years from about 10 per cent of the national budget in the 1960s to about five per cent in the 1980s before rising to about six per cent in the 1990s. In addition the percentage allocated to personal costs has been increasing (now about 85 per cent), leaving less and less for the purchase of medication, supplies and maintenance of the facilities.
What is clear is that finding supplemental financing to support the budget for health care in order to reduce the burden on individuals and the state alike, has to be found. Jamaica's expenditure on health services in the public and private sectors amounted to approximately US$350 million (J$21 billion) in 2002. The public sector accounted for about 46 per cent of total spending; individual out of pocket payments 36 per cent; private health insurance 16 per cent and gifts and grants two per cent (National Health Accounts estimates, 2002)
The NHF was designed as a new financing mechanism for health services in Jamaica. and as such a significant source of supplemental financing has been provided to assist in meeting the challenge of rising health care costs.
Revenue for the NHF is collected through the imposition of a levy on the consumption of tobacco products (about$billion), a payroll based tax of half a percentage contributed equally by employees collected with NIS and five per cent of the Special Consumption Tax. The NHF covers all persons normally resident in Jamaica suffering from one or more of 14 specified chronic conditions. Over 800 prescription items are on the NHF List with discounts/subsidies from 35 per cent to 50 per cent of the cost of these items. An Epidemiological Study conducted by the Ministry of Health made an assessment that 750,000 persons in Jamaica had a chronic illness.
Mr. Campbell made it clear that not all will require pharmaceutical treatment Some of these individuals will require only a lifestyle change to reverse their condition." We Jamaicans tend to have a reluctance to know the state of our health unless we get sick.
To support his point he drew attention to the Lifestyle Survey of 2000, conducted by the Ministry of Health and the University Hospital of the West Indies which discovered that only 55 per cent of persons with high blood pressure knew that they had the condition; only 76 of persons with diabetes knew they had the condition. In addition only 42 per cent of persons with high blood pressure were on treatment and 67 per cent of diabetics. Even so among those on treatment 38 per cent of hypertensives and 40 per cent of diabetics were under control
Mr. Campbell declared: "The Government should move with considerable dispatch in the rationalisation of health financing agencies to achieve both economy of scale, critical mass and thereby reduce the seemingly territorial and patently obvious high administrative costs in the fragmentation of health financing. More specifically the Government must act mow. Health financing components of all agencies should be consolidated in one statutory body with the adequacy and competency in human, technological and financial resources."
