Editorial | NHF a model

There are not too many opportunities to celebrate Jamaican government agencies for the quality of their customer service and general efficiency. That is because too few of them are worthy of it.

The National Health Fund (NHF) breaks that mould. And has done so for two decades. So this newspaper unreservedly congratulates the NHF on 20 years of existence.

This anniversary, which the NHF marked with the publication of a newspaper supplement on Friday, highlights two apparently disparate issues, although both are critical to national development.

The first is that bumbling bureaucracy is not inevitable in the public sector. Taxpayers and other customers not only deserve, but can get good, timely service as almost anyone who interacts with the NHF will attest.

Indeed, it requires hardly more than half an hour for a prospective NHF beneficiary to have his application vetted and approved and to leave the NHF’s office with his health card, once the patient’s document was appropriately evaluated and signed by his doctor. Significantly, too, especially for an agency, a substantial part of whose operation is paying health-service providers, the NHF has largely escaped scandal and allegations of corruption.

CASE STUDIES

In this regard, as part of the administration’s Public Sector Transformation Project, the NHF, and the handful of other government agencies with similar reputations, should be subjects of case studies so that other bodies can, where applicable, replicate their models, including management regimes.

The second observation is that the marking of the NHF’s 20th anniversary reminds of past questions about the sustainability of the fund and places back on the agenda the issue of whether it can, or should, morph into a national health insurance scheme. Indeed, there is an allusion to the latter issue in the subtitle of the NHF’s anniversary supplement: ‘Reigniting the Health Financing Agenda’ But except for Shadow Health Minister Morris Guy’s passing observation that part of the NHF’s mission for the next 20 years was to play “a pivotal role in the provision of a universal healthcare to improve the quality of life of our citizens”, the matter was not significantly addressed in the tributes by various officials.

Financed primarily by 20 per cent of the special consumption tax (SCT) levied on tobacco sales, five per cent of the earnings from other SCTs, and one per cent of National Insurance Scheme (NIS) contributions, the NHF pays a hefty portion of the prescription costs of patients with non-communicable diseases (NCDs) such as hypertension, diabetes, as well some cancers. It has over three-quarter million beneficiaries, including older Jamaicans covered under the NIS, on its register.

The health minister, Christopher Tufton, raised the issue of the NHF’s sustainability in a parliamentary address last year, noting that the cost of its co-pays for drugs had risen by 139 per cent in the six financial years up to 2021-22 to J$11 billion. He projected these costs to rise by another 30 per cent over the next three years, to 2025-26. Dr Tufton warned that the burden on the NHF for drugs and other services – which could push its overall costs past J$40 billion – could become unbearable.

CRISIS OF LIFESTYLE DISEASES

A major driver of this hike was the rapidly spiralling price of drugs and Jamaica’s crisis of lifestyle diseases. For example, 30 per cent of Jamaicans are hypertensive, half are overweight to obese, and 12.5 per cent suffer from diabetes.

While the Government’s policy is to promote healthy lifestyles to reverse this high incidence of NCDs, the existing problem, compounded by an ageing population, means that the Government has to consider alternative models for financing healthcare, on which the country, in 2020, spent approximately 6.6 per cent of GDP, of which the Government’s outlay was estimated at 65 per cent.

Fewer than a quarter of Jamaicans have private health insurance, and a large chunk of those who do are public-sector employees who are part of government-supported schemes.

For decades, governments have discussed the possibility of a universal health insurance scheme. At points, the NHF was seen as a possible stepping stone towards the creation of such a system that would also leverage existing private arrangements.

These discussions, despite several studies, have not as yet led to the drafting of a specific model, although Dr Tufton announced nearly two years ago that consultants had been hired to do just that.

In August, the minister again called on Parliament for “comprehensive dialogue” towards this universal system but said nothing about the work he previously commissioned. The NHF’s 20th anniversary is a good time for the minister to provide a concrete update on the national health insurance project.