Judging Health Care spending in Barbados.
Dr. C.V. Alert MB BS, DM.
On Tuesday July 18th 2017, in one section of the Barbadian press, the ruling party in Barbados, the DLP presented a full page advertisement, part 1 of its FACTS series on Health Care. . In one line of the article, the DLP points out that the Government spent BDS $ 450M on Health care in 2016//2017.
Later in the same article, in a table documenting the “Recurrent health spending by sources of financing” the figure recorded in the table under Government’s spending is BDS $ 405.2M.
So where has the BDS $44.8M gone? Is this money unaccountable? Are we just supposed to ignore this sum, as the authors of the article have apparently done? Is the ‘disappearance’ of large sums of money to be treated as 'a government business as usual’ procedure? Is this what happened in previous years? At best, this may represent poor arithmetic skills, and a sloppy approach by the authors to reviewing their own public relations effort. At worse, it justifies the recent call by Professor Sir Frank Alleyne for a Contractor General to investigate government finances, and to initiate appropriate action when necessary.
Also important in assessing whether the sum ($450M or $405.2M) that the government spends on health is being well spent (or otherwise) is an assessment of what is happening with the national health. The annual reports of the Chief Medical Officer (CMO) give us a limited view of the national health picture, and also provide some important national medical statistics and trends. Unfortunately, the most recent publically available CMO’s report stops at the year 2009. [It may be coincidental that the DLP were first elected in 2008.] This means that objective data on our national health picture has not been made available to those outside of the Ministry of Health, for the last 7 years.
In 2015, the results of the Barbados Health of the Nation (HotN) study were published. This study, commissioned by the Ministry of Health, looked at the health of Barbadian adults aged 25 years and over, was conducted by the Chronic Disease Research Centre (CDRC), in conjunction with the Faculty of Medicine, UWI, Cave Hill. The authors of the study (which included a senior official in the Ministry of Health) concluded that “urgent action is required to address the low levels of healthy behavioral risk and high levels of biological risk present in the Barbadian adult population”. However, we are still waiting on a public comment from the Ministry of Health on how/when/where/what urgent action will be implemented to improve the health of Barbadians, given the magnitude of ‘poor health’ identified in the study, and perhaps to lower health care costs as well.
The DLP should also tell us what is happening to the recommendations that were received during the five town hall meetings held early in 2016 across Barbados on Health Care Sector Financing Reform. This follows comments made during the recent national budget debate that the National Social Responsibility Levy (NSRL), recently increased by 400%, was designed to provide for Education and Health. It was noticed that, one week after the NSRL was implemented on July 1st 2017, the Minister of Health ‘floated’ the concept of a national health levy. At least we can speculate on what the Minister of Health thinks about the likelihood of the NSRL being able to fix the financial woes associated with health.
One looks forward to the ruling DLP to present additional ‘FACTS’ on the actual spending in health, and to supply the statistics on Barbados' national health picture during the last 8 years under their watch. We may be able to see where the millions have ‘apparently disappeared’, where our health picture actually is, and where we are headed.