Introduction and Purpose of Research
In 2008, the governing party, Jamaica Labour Party (JLP),
implemented a no user fee policy for healthcare. With this, a
myriad of benefits, question and shortcoming have presented
themselves.Heath care, in most developing countries such as
Jamaica, is a serious cause for concern. This is due to the lack of
resources such as staff and proper equipment and mismanagement of
the little we have. The main reason for this is funding; the lack
thereof. Many critics have questioned the feasibility of the free
healthcare and its sustainability in Jamaica. With the
implementation of free healthcare, is Jamaica setting itself up for
improved services in this sector? and With Jamaicas current
economy, how will this really be paid for? are a few of the
questions raised by the sceptics who thought the ideology beneath
this proposal was fundamentally flawed. (JIS, 2008)However the
aforementioned concerns were quietly by the health minister later
in 2009 that the benefits from the no user fee policy outweigh the
sacrifices. Now, after 6 years and a change of governments, the
policy is still in place. How has this policy really benefit
Jamaicans, especially those of the lower echelons of society? This
and aforementioned questions drove me to select the subtheme:
Healthcare and economy under the theme: Health derived the focus of
my study to be: Investigating the benefits and shortcomings of the
no-user fee policy (free healthcare) for the members of the
communities of Lakes Pen and Lime Tree. The research is aimed at
investigating the following: What percentage of the population of
these communities uses this free healthcare? Which social and
economic tiers utilize this no user fee policy mostly? How often
are these services utilized? How beneficial have the services
provided been? What are the problems faced at health centres?It is
important that the country and its citizens continuously assess and
redefine certain policies in order to be not only proactive but to
also move forward. This research bears significant educational
value mainly because as future leaders we have the tasks to
evaluate the good that our predecessor has done and build upon and
to remove all aspects of the past that worked only to our demise.
This research is geared towards addressing the issue of whether or
not this is one such policy.Definition of Key Terms:Echelon, as
defined by the Oxford English dictionary, is a level or rank in
society, a social classUser fee, as define by dictionary.com, is a
charge amassed when a person uses a specific service. A business
which makes use of this is banks. The lack of user fee therefore
implies that this fee is not paid by users and the service can be
said to be free.Economy, as defined the Oxford English Dictionary,
is a system consisting of production, distribution and trade and
lastly the consumption of goods and services within a given
area.
Literature Review
The need for healthcare worldwide has increased tremendously
with the increasing global population. We see since the industrial
revolution the world's population has approximately double. In
addition, with advancements in transportation the world is no
longer separated masses of land but a global village in which each
country bears significant weight on global stability, however some
more than others. With these truths being present, the transfer of
diseases has become just as easy as making a phone call and the
need for readily available and affordable healthcare and medication
has been on the increase exponentially. (Fuchs, 2000)Free
healthcare provides an avenue for all citizens to achieve or gain
an acceptable level of healthcare. It may also have negative spin
offs where due to the increase of the demand and usage of
facilities will cause the rapid diminishing of the quality of
healthcare facilities. This source gave background information
which was useful in the development of the research plan and ideas.
A number of shortcomings were noticed throughout the planning and
implementation of the policy and documented via a research journal.
These are: cost of healthcare not aligned with patient outcomes;
primarily because of the lack of a patient-focused approach to the
delivery of health services, inadequate budgetary support for the
MOH which has resulted in poorly staffed and poorly stocked
healthcare facilities and underfunding resulting in a deterioration
of the Jamaican health sectors and finally, a dysfunctional health
reform process (regionalization) which has demonstrated: ageing and
poorly maintained medical equipment and physical plants, poor
implementation of changes, including the no-user-fee policy and
lack of dialogue and participation in the decision-making processes
across the sector. (De La Haye, 2011) The journal presented a well
of knowledge surrounding the operations involved in implementing
this policy.The source also highlighted plans designed to increase
the efficiency of the policy which should have being set in place.
For example: increased staff at specific hospital which often see
patients waiting for unbearable times due to the high demand of the
service provided by the hospitals and also the purchasing and
implementation of several equipment valued at over 2.7 million US
dollars. These sources were useful in giving background information
on the research and also in the development of the research
objectives.According to a journal there are two major concerns
about the policy implemented originally by the JLP and perpetuated
by the PNP. These are how much of these cost exempted to users are
covered by taxes and how much do these exemptions affect the health
and economic sectors of the country? The previous cabinet after
slating out the budget explained that a portion of the budget will
be directed towards this and other moneys will come from other
sources. The new governing body, PNP implemented the same system of
paying for this free healthcare but the question still remains as
how does this affect development of and the sustainability of
healthcare facilities. These fees that were formerly paid helped in
the maintenance of hospital and hospital facilities. However, they
warded off members of the lower social and financial tiers of
society. (CAPRI, 2013) The journal furthered dissected the benefits
by placing statistics and tables of the progress of the policy in
several parishes especially those of a greater population. For
example: Spanish Town Public Hospital, Kingston Public Hospital,
May Pen Hospital and the Mandeville Hospital. The journal provided
statistics and graphs and in essence fuelled how I decided to do my
presentation of data further in this documentation.Since the
implementation of the policy it is reported that the poor has
benefitted tremendously by the policy and the JLP were commended
for having put it in place. Though this is true one begs to
question if so much of the countries resources should be geared
towards this effort and how medical staff, having to work long
hours is affected. Many healthcare workers complain about the
facilities and the number of patients they offer services to daily.
There is insufficient staff and as a results worsening poor
service. (Cunningham, 2013) This article, having decided to engage
in an interview, helped me to develop my interview questions.
Hundreds of thousands of Jamaicans have benefited from the no user
fee policy over the years since its inception. As a result many
sceptics have become more confident in the choices made in relation
to this concept of free healthcare. Not only did it boost the
nations health and awareness of diseases but members of the
population living with HIV/AIDS have gained medication which would
otherwise be extremely expensive to procure. (Willis, 2013)
Approximately, 86 percent of Jamaica makes use of this policy
regularly and 68 percent as their only mean of healthcare. (Henry,
2012) However the services provided, assessed by a survey completed
by CAPRI funded by the International Development Research Centre in
Ottawa, Canada, The Gleaner Company Limited and the National Health
Fund were found to be limited and of a barely acceptable standard.
It was also shown that the majority of the patients who benefitted
were asthmatics, the elderly with non-terminal diseases, and
pregnant women from inner city communities. This provided a bench
mark by which several quantifiable information, expected to be
receive, will be compared.There remains an ongoing debate as to how
the healthcare reform surrounding the no-user fee policy affects
Jamaica and what effects, both positive and negative, does it have
on the economy. Several political commentators and state ministers
have, over the years, engaged in cross talk over this issue and
despite the highlighting of several shortcomings the policy is
still in effect. Parliament is currently reviewing the policy to
implement a those you can pay should pay policy. This is due to the
discomfort of doctors who continue to work despite the worsening
condition to facilities, worsening pays, high inflation and fear of
termination of contracts. (Hibbert, 2015)The topic of healthcare
and its effects on the economy is by no means exhaustive due to the
constant morphing and evolution of the two sectors with changing
populations. This research will try to educate and achieve a level
of insight into the specified theme.
Data Collection Sources
A combination of primary and secondary sources was used to
conduct this research paper. Survey was the selected research
method using questionnaires as the instrument; the researcher chose
a quantitative approach. The main source of primary data therefore
came from the questionnaires which were manually distributed to 25
persons using stratified sampling. The questionnaire consisted of
12 questions; 10 close-ended with a number of choices being given
and 2 open-ended response questions. Each selected individual was
approached and asked whether they would be interested in
participating in the study. The time taken for an individual to
complete the questionnaire was estimated five
minutes.Questionnaires were chosen as they are concise and easy to
fill out and were also easy to administer as many can be done at a
time without face-to-face interactions. They were manually
distributed because this was cost and time effective as the
communities selected were relatively small and within close
proximity of each other. Confidentiality of information is
important and questionnaires serve to facilitate this. The
questionnaire contributed to the study by obtaining quantifiable
data for further analysis.The other source of primary data came
from an interview with doctor Landel, a medical doctor at the
Spanish Town Hospital, which serves the majority of these
communities healthcare needs. The interview took approximately five
minutes and was structured, consisting of only four questions. It
was used to test findings from the questionnaire and provided an in
depth analysis because it was extensive and involved face-to-face
interaction. Additionally, the interviewer was able to interpret
verbal and nonverbal responses and thus, make reasonable deductions
and comparisons. The secondary sources of information came in the
form of internet sources, published books, journal and magazine and
newspaper articles as well as past research. The secondary sources
were used to obtain general knowledge on the topic as well as any
statistics that could support the research. This provided several
perspectives and aided in broadening insight. Lastly, they provided
a wealth of similar and contrasting views.
Presentation of Data
Questionnaire Results:
Figure 1: Age group of respondents
Figure 2: Gender of Respondents
Figure 3: Respondents who use public healthcare services
Figure 3.1: Respondents who have no other alternative
Figure 4: Frequency of visit to facilities
Figure 5: Reason for visiting healthcare facilities
Number of RespondentProblems faced by respondent at public
health centres
3I dont use these facilities
4Long waiting period
1Lack of information
2Postponing of appointments
3Staff absent
2Impolite staff
5Poor facilities
2Recommended elsewhere
2Incorrect diagnoses
2I havent experienced much problem at public health centres
Figure 6: Problems faced by respondents
Figure 7: Employment of Respondents
Figure 8: Monthly Income of Respondents
Figure 9: Highest level of Education of Respondents
Figure 10: How Beneficial Services Are Provided Number of
RespondentsWays to increase the quality of services provided
6Increase funding to public healthcare facilities
4Increase the number of staff workers
3Government needs to review the policy and improve it
3Build bigger hospitals with better facilities
3I dont think it can be improved
1Make public clinic services 24-hour
2Pay staff better; it will motivate them to improve their
performance
2Improve public education about preventative measures for
diseases to limit the dependency on public health facilities
1Improve the archiving of patient records to reduce waiting
time.
Figure 11: Ways to increase quality of services
Figure 12: Respondent view of the policy
Interview ResultInterview with Doctor Landel (MD) on call at the
Spanish Town Hospital and Clinic Interviewer: On a daily basis what
is the doctor to patient ratio and how has the implementation of
the no-user fee policy affected this?Dr Landel: I am currently
stationed in the casualties department; the average day sees 6
doctors in rotation between day and night. On a daily basis we
receive about 230 patients, most of which are not serious but at
least 2-5 serious cases and possible admittances. Since the
implementation of the policy, I have seen increases in the amount
of patients. I would say about an 80 percent increase.Interviewer:
What types of cases are more common?Dr Landel: Well, majority of
the patients I look at obtain injury through domestic violence and
unfortunate accident (motor vehicles included). Asthmatics and the
elderly are also a large percentage of the cases I
receive.Interviewer: How beneficial do you think the policy is?Dr
Landel: I think it has benefitted the majority of Jamaican people.
It definitely has benefitted the poor and the elderly. However,
doctors and nurses have seen a tremendous increase in the workload
and barely any increases in salary.Interview: How do you think the
policy can be improved?Dr Landel: I believe that if more funding
can be placed into healthcare to improve facilities and equipment
available then an increase in the healthcare provided will be seen.
Also, if we see an increase of specialised doctors across the many
specifications (urology, cardiology, paediatrics, endocrinology
etc.) the policy can be better complemented. Lastly, public
education of how to avoid certain illnesses and preventative
measure would have a spin off which sees less person running to the
hospital for common illness such as colds and fevers.
Analysis of Data
The questionnaire highlighted several trends. An overshadowing
majority of participants as seen in figure 3, 88 percent stated
that they used the services of the public healthcare. This implies
that the bulk of the population makes use of the no-user fee
policy; that is approximately every 9 of 10 persons makes use of
these amenities. Figure 3.1 shows that of the 88 percent, 72
percent state that this is their only affordable means of
healthcare. In addition 68 percent say they use the services
sometimes or often based on figure 4. In investigating the reason
for using service we see where immunization and general
checks/casualties are the main driving force; contrary to what
previous research show. A combination of the two encompassed 40
percent. Following those two asthma, dental checks and natal care
combined for 36 percent. Figure 6 displayed the result of an open
ended question. The researcher was able to quantify the results
using keys term and grouping the general idea of what participants
were implying. It revealed the most prevalent shortcomings noticed
were absenteeism of staff, poor facilities and extensive waiting.
These 3 combined for 48 percent. It also showed that only 8 percent
have not experienced any problems. Figure 7 displayed the trends in
employment where a greater percentage (56) was employed. The
majority of the unemployed participants were over the age of 55 (Of
the 44% unemployed, 64% of that was the elderly). Figure 8 also
delved into matters of employment and personal economy. We see
where 76 percent of participants obtained less than $50,000 monthly
with salary ranges of $15,000 to $30,000 and $30,000 to $50,000
both contributing 28 percent. This shows that the majority is low
to medium wage earners. This result is substantiated by figured 9
which show that 52 percent have received on a secondary level
education and another 16 percent receiving only primary level of
education. 60 percent stated that the services provided were
beneficial to extremely beneficial. This shows that a majority have
benefitted reasonably to tremendously from the no-user policy based
on figure 10. Figure 11 was also open ended and the aforementioned
method was applied to quantify information. Most persons stated
that they believe that increase funding and obtaining better
facilities would improve the services. This majority are in
concordance with Dr Landel who provided the same ideas as to how
services can be improved. Majority of participants have a positive
outlook on the implementation of the policy with 60 percent
reporting that it was a good thing. 12 percent however, was
indifferent to the policy. This 12 percent was wholly comprised of
the 12 percent that stated that they do not benefit from the
services. One major fact which was highlighted by doctor Landel is
the fact that he said the number of patients he see on average has
increase by 80 percent. This means that for every 5 patient that on
average would see him daily, 4 new patients are present now.
Discussion of Findings
The analysed findings displayed trends which support and counter
previous research sources. Through thorough analysis and
comparison, findings show that 88 percent of the population of the
participant utilise the services of the policy. Of this 88 percent
72 percent utilise this as their only affordable means of
healthcare. This supports the research presented by Henry (2012)
that states that 82 percent uses the services and 68 percent have
no other affordable means. This implies that the dependency of the
population on the policy is consistent and the policy has truly
benefitted a great deal of the population. Of the entire population
68 percent says they utilise the services sometimes or often. The
main reasons being immunization followed by general
checks/casualties which amassed 40 percent. This is an anomaly as
it counters precedent findings which stated that the majority of
cases come from HIV/AIDS and natal care patients as presented by
Willis (2013). In relation to the question surrounding the major
concern or shortcoming of the policy was said to be the poor
facilities; this stated by 20 percent. This support expectations
and presented Fuchs (2000). This also support the information
presented CAPRI (2013). This shows that there is a consistency in
findings which indicate this to be of concern moving forward. The
implications worsening facilities may have on the healthcare can,
at this rate, lead to spiralling degradation of the sector; more so
than present. The finding show that 56 percent of the population is
employed however, a whopping 78 percent are low to medium income
earners. This implies that previous findings presented by Henry
(2013) are accurate which state that the poor benefits tremendously
from the policy. This relates to the aforementioned dependency on
the policy as many persons cannot afford alternative healthcare.
The findings also show that the majority of the population had not
received more than a secondary education. Interpreting these
findings of employment, salary earned and educational it is
possible to deduce that the majority of the population which
benefits from the policy is found within lower to middle
socio-economic classes. This also supports findings previous noted
by CAPRI (2013). 60 percent state the policy was beneficial to
extremely beneficial to them. Overall, 84 percent stated that the
service has benefitted them in some way. This corresponds with
findings by CAPRI (2013). This show that the policy benefits 4 of
every 5 Jamaicans; this has been the major driving force behind the
longevity of the policy. This is further emphasised by the
interview completed, I think it has benefitted the majority of
Jamaican people. It definitely has benefitted the poor and the
elderly, (Landel, 2014) - in response to the question of how
beneficial the policy was. The majority expressed views that
increased funding will increase the quality of services provided by
the policy. 24 percent stated that the policy required greater
funding and an additional 16 percent stated that the improvement of
staff would bring the services provided to an increased efficiency.
This is in agreement with surveys completed by CAPRI (2013) and is
supported by information presented by De La Haye (2011). With this
in mind one question what measure will be put in place to remedy
the issue of inadequate funding or rather, if anything can be done.
Surprisingly, only 60 percent expressed a positive view on the
policy. This is shy of in excess of 20 percent as expected due to
previous findings presented by CAPRI (2013). This anomaly may be as
a result of assessment overtime or just due to the focus population
of the research. However, results still indicate that the majority
of the population have a positive outlook on the policy.Comparison
this research to previous research, it can be highlighted that
major similarities are seen. These similarities, though some
expressed more than others, indicate consistency of information and
may be indicate of future occurrences. This research is beneficial
as it provides members of a future generation with statistic and
diagrammatic representation of the issue of free healthcare with
the two aforementioned communities. This research shows major
similarities with previous research. This implies that the
shortcomings found are recurring issues that not only the doctors
who are greatly affected face but the entire population. This
indicate that though the policy is branded as beneficial, there are
major inefficiency which overtime, if not fixed, may derail the
policy entirely. The study will be a significant endeavour in the
reviewing of the policy. The study will also be beneficial to
future research as it will not serves as bench mark statistics but
will relate information surround the concept of the no-user fee
policy and the issue and recommendations of people who provide the
services and those who use it. Moreover the research will provide
educated recommendations on how to evaluate and improve
performances of policies implemented.
Conclusions
From the study conducted, the researcher sees where the no-user
fee policy has benefit the majority of the sample population. It
was found that the majority of the population has a positive
outlook on the policy and the major downfall of the policy is a
lack of facilities or poor facilities due to a lack of funding.
Based on findings, it is safe to conclude that the member of the
communities of Lakes Pen and Lime Tree have benefitted
significantly from the policy however, the major issue faced is
that of the conditions of facilities.
Limitations
The respondent may not have truthfully completed questionnaires.
Some questions may have sensitive to individuals; question about
employment and monthly salary are sensitive and may not have
received factual responses. Some respondents may have given
socially desirable responses. The questions were mostly closed
ended and respondent may not have been fully able to express their
views. In analysing and presenting open ended questions the
responses were categorised based on rubrics hence full responses
were not presented as it would have been tedious The method of
investigation was mainly quantitative to produce graphs and charts
etc., however, the may result in major qualitative data not been
received which may great implications on the research.
Recommendations
Based on finding several recommendations were made. Firstly,
public education about diseases and personal healthcare will not
only limit the strain on the policy but will also increase the
overall health of the population. Secondly, increase funding and
greater monitoring of this funding will see not only an increase in
the quality of services and facilities but will limit the
mismanagement of resources due to corruption. In addition, a
reviewing of the policy to amend who benefits directly from the
absence of user-fees will lessen the strain on the economy. If
members of the population who are capable of paying user-fees are
force to pay it will result in necessary funding being present to
not only increase the salaries of healthcare workers such as doctor
but will also provide funding for improving facilities hence
improving services.
Bibliography
CAPRI (2013) No User Fee Policy in Public Hospitals in
JamaicaPublished: May 2013
Cunningham, A. (2013) Free Health Fallout - Too Much Freeness -
No-User-Fee Policy Worsening Poor ServiceJamaica GleanerDated: June
11, 2013
De La Haye (2011) West Indian Medical Journal The impact of a
no-user-fee policy on the quality of patient care/service delivery
in
Jamaicahttp://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S0043-31442012000200013Department
of Community Health and PsychiatryUniversity of the West Indies
Fuchs, V. (2007) Essays in the Economics of Health and Medical
CareNBER publishersChapter Title: The growing demand for medical
care
Hibbert, K. (2015) Doctors want pressure applied to government
to fix health sectorJamaica ObserverDated: January 8, 2015Retrieved
from:
http://www.jamaicaobserver.com/news/Doctors-want-pressure-applied-to-gov-t-to-fix-health-sector_18189598
Henry, B. (2012) Opposition says no-user fee saves patients
$8bRetrieved from:
http://www.jamaicaobserver.com/news/Opposition-says-no-user-fee-policy-saved-patients--8b_12165921
Dated: August 08, 2012
Lagarde, M. Palmer, N. The impact of user fees on access to
health services in low- and middle-income countries. Cochrane
(2011) http://apps.who.int/rhl/reviews/CD009094.pdf
Willis, A. (2013) Free Healthcare A BlessingJamaica
ObserverDated: November 27, 2013
AppendicesQuestionnaireThis survey seeks your opinion on the no
user-fee policy which whether directly or indirectly affects every
citizen of Jamaica. The no-user fee policy is the policy which
allows person to utilize public healthcare services without a cost
being allotted to them (free healthcare). Indifference is define as
a lack of interest or concern; not caring.
Please answer all questions as appropriately as possible. If a
question does not apply to you, you may leave your answer blank or
simple state that it doesnt apply.
Please select by ticking the appropriate response
1. Age group: 13-25 26-40 41-55 Above 552. Sex: Male Female
3. Do you use public healthcare facilities (public hospital and
clinic)? Yes No
3.1 Can you afford to utilize other means? Yes No
4. How often do you use public healthcare facilities?
NeverRarelySometimesOften
5. What is the main type of care you utilise from these
facilities?
I do not utilise these services Asthma Chronic Disease Dentals
General Check-ups/ Casualties Immunization Pre/Post Natal
Other, please specify _________________________________
6. What issues/problems did you experience at the public
healthcare facilities? (If you dont use public healthcare
facilities just state that you dont use the facilities)
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
7. Are you currently employed? (Self-employed or otherwise)
Yes No
8. How much money do you earn monthly? under 15,00 15,000 -
30,000 30,000 - 50,000 50,000 - 100,000 100,000 200,000 over
200,0009. What is your highest level of education? Primary
Secondary Undergraduate Graduate10. How beneficial are the services
provided at these healthcare facilities? Extremely Very Beneficial
Somewhat Not
11. What measure can be implemented to improve the quality of
services
provided?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
12 What is your view (outlook) on the implementation of the
policy? (Do you think it was a policy to implement?)
Yes, I think it was a good to implement No, I dont think it was
a good thing to implement Indifferent
Maps
Figure i: road map of area Figure ii: satellite image of
area24