The Editor, Sir:

It is an exciting time to be a health-care provider in the public health sector. It seems that at long last, health has been placed on the high priority list by both major political parties. The current government has pumped hundreds of millions of dollars into the public health sector over the past six months. Several hospitals have received much-needed renovations and upgrading of the physical infrastructure. Whether or not this was all part of the preparation for Cricket World Cup 2007, the improvements were necessary and in fact more work is needed.

Two new health centres are scheduled to be built, as recently announced by Minister Horace Dalley. There are plans to build a new hospital for children in Western Jamaica. Our diagnostic capabilities have received a much-needed boostwith the provision of just under $2 million of radiology equipment. The long-awaited CT scan has arrived at the Kingston Public Hospital and the MRI machine is on its way. The cherry-on-top is that the KPH and Victoria Jubilee Hospitals are in the process of receiving a much-needed facelift. Hopefully, the interior of the hospitals will also receive some attention.

What has been overlooked is the fact that each development brings additional costs. For example, to obtain the maximum benefit from the CT scan, the facility should be available on a 24-hour basis. This means that there will need to be additional staff allocation, including radiologists (doctors), radiographers and additional overtime. There will no doubt be an increase in the electricity consumption at the hospital and there will be additional maintenance costs. The MRI machine will likewise result in additional expenditure. The two new health centres and the new hospital will have to be staffed and stocked with drugs, stationery and medical equipment.

Coinciding with these developments and tremendous expenditure, the Prime Minister has announced an abolition of hospital user fees for patients up to the age of 18. This will result in significant loss of revenue which, in the past, could not even offset the annual budgetary shortfall. The Opposition has been even bolder in their promise of free health care for all. As medical professionals, we applaud any move that improves access to health care for any segment of the population, especially those who need it most, and those who can least afford it. However, we must face the awful truth that health care is expensive. Someone always has to pay.

Neither the Government nor the Opposition has been very clear as to how the proposed changes in health are to be paid for.

The fear of 'too much too fast' is the main thing that dampens our excitement as health care professionals. We fear that the thrust for political gain will result in eventual loss for those that deliver health care and those that utilize the health facilities. We anticipate that these issues will be clarified during the run-up to the next election.

Health-care reform needs to be a process and should be well thought out, with each change implemented in a timely manner and in consultation with representatives of all the stakeholders. Health-care financing needs to be placed on to the national agenda for discussion and might best be dealt with through partnership between the public and private sector. The euphoria resulting from political speeches needs to be tempered with a touch of reality.

I am, etc.,

Dr. MYRTON SMITH

myrtonsmith@hotmail.com

President

Jamaica Medical Doctors' Association

Kingston 5

Via Go-Jamaica