Erica Virtue, Senior Gleaner Writer
Within weeks, Jamaicans will know whether or not the island will return to the payment of user fees to access all public-health services. The no-user-fee policy, introduced in 2008 by the Bruce Golding-led Jamaica Labour Party (JLP) administration, is to be 'tweaked' by the Government.
And the Opposition is watching closely to see what changes will be made to a policy it considers fundamental.
"The Jamaica Labour Party stands by its no-user-fee policy in health and education. We see these as entitlements that the State should provide to its citizens as the minimum support for their development," Opposition Leader Andrew Holness told The Sunday Gleaner.
"In health, we believe that the citizens should not be asked to pay in the public system at the point of accessing the service," added Holness.
He said the Opposition would not be against a contributory system that is income-contingent or proportional.
Last year, Health Minister Dr Fenton Ferguson announced that two studies were to be done to review the no-user-fee policy in the government health sector.
At that time, Ferguson said the Government was committed to universal access to care at the primary-care level, but was concerned about the State's ability to adequately fund quality care across the system.
Now it seems those studies are done and Ferguson is awaiting the green light from his Cabinet colleagues to announce changes to the system.
"It is not that the user fees will be reintroduced wholesale but those that can pay will have to pay," a source close to the Government told The Sunday Gleaner late last week.
"Fenton will make the announcement shortly, but we cannot afford to continue operating the hospitals like this," added the source, who noted that other changes are also being planned for the health sector.
The Sunday Gleaner has been told that a recommendation for the fee adjustment has already been done and if it is not yet before the Cabinet, it should be there within days.
The source argued that the current no-user-fee policy has left many hospitals in acute pain.
Describing as ridiculous the fees structure in the health sector, the source said the new structure will provide more funding for hospitals.
"A group of persons was put together by the minister to look at a new fee structure. So we have come up with a new fee structure. I think it has been approved by Cabinet, or is to go before Cabinet, but a new fee structure is in place," said The Sunday Gleaner source who requested anonymity.
"The new fee structure is primarily not to charge the public more fees, because the no-user-fee policy is not being abandoned. However, fees will come for insurance purposes, so that we can then kick in our collection. Persons who are foreigners or persons who are insured ought to be paying for services," insisted the source.
More than a billion dollars is currently owed to all the public hospitals involved in the no-user-fee policy.
Now the Government wants to encourage patients with health insurance to take advantage of the incentives available at public hospitals.
"We are trying to create some incentives for them, maybe an express line for those with insurance because it's going to be a revenue base for us to pump back into the system to help those who are not insured.
"That is a major programme we have to put in place that's going to be robustly driven."
This will not be opposed by Holness, who accepts that there are many contributory private health schemes that need to be integrated to include individuals who are privately insured, but who use the public system for free.
Holness said the Opposition is open to look at models that could offset the cost of health care to those who need it most.
In the meantime, another policy to be introduced is a complete overhaul and retrofitting of the accident and emergency departments of most public hospitals, starting with the major facilities in the South East Regional Health Authority system.
The policy is aimed at quickly assessing and determining the ability of persons to wait when they enter emergency departments for treatment.
That decision was informed by reports in the local media of patients waiting more than 10 hours from entry to exit at some hospitals.
Studies conducted in hospitals in some of the major states in America, including New York, New Jersey and Maryland showed that the maximum waiting time was about three-and- a-half hours.
"Patient care, the quality of service, how you talk to them, how to communicate the care to them so that when they leave they leave with a clear understanding of their health issues are also going to come in for sharp focus," said the source.
Consultants will also be playing a major role in the accident and emergency departments as part of a thrust to improve patient care.