National Health Care Spending in Trinidad and Tobago
May, 23rd, 2011
Steve Linerode National health care spending in Trinidad and Tobago
???One of the most important questions facing health care economists and policy-makers in general is, how much of a nation??™s wealth should be devoted to health care. One problem that plagues any attempt to address national health care policy is the time it takes for health care spending to respond to major economic changes, such as a drop in gross domestic product (GDP) or inflation. Policy makers attempt to control costs by imposing regulations on the health care system, but because of the slow pace of economic change, it is difficult to know whether regulations are necessary or even effective. An added problem is that most health care spending is for labour, so cost containment measures often involve cutting wages or laying off personnel, which are always unpopular actions??? (Getzen and Allen, 2007, p. 300). Health and development are intimately connected. Good health is central to human happiness and well-being, and makes an important contribution to national progress. ???Health care costs so much because people place so much value on their health??? (Getzen & Moore, 2007, p. 13). ). All stakeholders involved in health care spending today must take into consideration such important factors, inter alia, as the country??™s current financial status, budget constraints, the prevailing global economic depression, patient??™s rights, needs versus demands, cost-benefit ratios, scarcity and choice, for at the end of the day, ???money still determines health??? (Getzen & Moore, 2007). This paper takes a look at some of the factors pertinent to national health care spending in Trinidad and Tobago, a twin-island Republic in the West Indies with a population of 1.3 million people and an area of approximately 2,000 square miles, and provides a forecast of the future economic needs of the health care system in this island, of why these needs must be addressed, and the vision by which these needs may be financed.
Trinidad and Tobago (T&T)
Trinidad and Tobago, a Caribbean parliamentary democracy and former British colony, became independent in 1962. In May 2010, Kamla Persad-Bissessar and her People??™s Partnership coalition won 29 of 41 seats in parliament, ousting a government weakened by soaring crime and allegations of public corruption. Robust foreign investment since 1990 has made Trinidad and Tobago the Western Hemisphere??™s largest supplier of liquefied natural gas and one of CARICOM??™s largest and most industrialized economies. Its economy has doubled in size since 2002, with hydrocarbons accounting for more than 45 percent of GDP in 2008. However, the rate of growth slowed substantially in 2009??“2010.
T&T??™s health care system
Trinidad and Tobago? operates under a? two-tier health care? system. That is, there is the existence of both private health care facilities and public health care facilities. The Ministry of Health is responsible for leading the health sector. Responsibility for the provision of health care services in Trinidad and Tobago was devolved from the Ministry of Health to five Regional Health Authorities (RHAs) with the passing of the Regional Health Authorities Act No. 5 in 1994. The Ministry allocates resources to the RHAs (four in Trinidad and one in Tobago) to finance their operations. Citizens can access free health care at public health care facilities where health insurance is not required. However, the government is developing the National Health Service in which a package of services is to be determined, as well as a financing strategy. Public health care is free to everyone in Trinidad and Tobago and is paid for by the Government and taxpayers. Recently, the government launched? the Chronic Disease Assistance Program (CDAP), which provides all citizens with free prescription drugs and other pharmaceutical items, available in more than 250 pharmacies throughout the country, to combat a variety of health conditions. ???Trinidad and Tobago has moderate taxes. The top income tax rate and the standard corporate tax rate are 25 percent. Petroleum company profits are taxed at up to 50 percent. Other taxes include a value-added tax (VAT), a motor vehicle tax, a property tax, and a health surcharge. In the most recent year, overall tax revenue as a percentage of GDP declined significantly to 19.4 percent??? (Index of Economic Freedom, 2011). Health care services are offered on a? walk-in? basis. There are five major hospitals throughout the country as well as smaller health centres and District Health Facilities located regionally throughout.
Health care expenditures in T&T
The global economic crisis has been felt in Trinidad and Tobago, evidenced by shrinking income, international funding and remittances; increased unemployment; and the review of social programmes. The economic crisis is a threat to health care in several ways. In particular, there is reduced funding for health care infrastructure and initiatives for both the state and non-governmental organizations as well as civil society. In addition, there is the threat of increased poverty within the population exacerbating living conditions which can lead to additional health risks??”for example, poor diet. It is to be borne in mind that the economic downturn can lead to an increased demand for state health services which are free to the public but which the current system may not be able to meet. The allocation of 4.3 billion Trinidad and Tobago dollars out of a total projected expenditure of 49 billion dollars, by the Government of the Republic of Trinidad and Tobago to the Ministry of Health for the financial year 2010/201, has been deemed insufficient and inadequate by the four RHAs to meet the escalating costs of state-of-the-art health care in the public health care facilities. ???The 2011 budget calculation was based on a real GDP growth of 2%, an average inflation rate of 7%, an oil price of US $65 per barrel and a gas price of US $2.75 per mmbtu??? (Dookeran, 2010, p. 27). In his budget statement 2011, the Minister of Finance, Mr. Winston Dookeran acknowledged that ???Trinidad and Tobago is still way behind providing adequate and timely health care to most of our people. We are still short of hospitals. The capacity of existing health care is insufficient to meet our people??™s needs. Waiting times for surgical and testing procedures are still far too long. Even primary health care is insufficient??? (Dookeran, 2010, p. 5).
Future economic needs of the health care system in T&T
In Trinidad and Tobago, life expectancy has increased. Males born today can expect to live to 68.3 years and females can expect to live to 73.68 years. The elderly population age 60 years and over has expanded over the years. The social implications of this phenomenon revolve around the provision of health and other support services including old age pensions, insurance schemes, housing, transportation and long term care of the elderly. Heart disease continues to be the leading cause of death since the 1990??™s. Injuries and Violence has been the top reason for hospital admissions over the last three decades. Expenditure on Public Health as a percentage of GDP in 2009 was 2.41%. In its 5-year strategic plan, 2011 -2016, the government plans to construct more primary care centres, to upgrade and expand existing ones, and to construct five new modern hospitals equipped with state-of-the-art equipment. It is also currently undertaking a comprehensive costing of health services in the public and private health sector, plans to bring on-stream in the very near future the national insurance system, plans to conduct a National Health Needs Assessment and is currently looking at a new approach to working with the private sector, non-governmental organizations and other key stakeholders. The dire shortage of human resources for the health sector, which impacts both operations of the health system and the quality of the services offered at the health institutions, is believed to be linked to the level of remuneration afforded to health care professionals. Economists say that Trinidad and Tobago cannot, in the present economic climate, afford to pay higher wages to health care professionals working in the public health care facilities.
There is an urgent need to find sustainable ways to finance public health care. It is vital that stakeholders be engaged on the issues of financing of health care, in particular members of the public, who must embrace and contribute to the system. To this end, consumers must be clear on the benefits that will accrue to them, bearing in mind the low level of confidence in the current system. Health care providers can cut costs by avoiding wastage of drugs and equipment, unnecessary tests, unnecessary admissions to hospitals and unethical practices in the management of patients. ???One possible goal of health care is the prolongation of life??? (Garrett, Baillie, McGeehan & Garrett, 2010, p. 85). ). Though currently there is now a wide variety of means to extend life, such life-prolonging efforts are tremendously expensive. ???For example, one-quarter of all Medicare funds in the US are spent during the last year of a person??™s life, and most of that is spent during the last month. Much of this money is spent prolonging dying, and represents scarce resources that could be used to maintain and improve health??? (Garrett, et al, 2010, p. 86).
The introduction of occupational health and safety (OSH) legislation and systems, the adoption of a preventative approach and the vigilant monitoring of OSH requirements in Trinidad and Tobago can ease the burden on the health care system from workplace accidents and illnesses, and thereby lead to a reduction in health care spending. The government has also embarked on programs to encourage persons to take responsibility for their health and to adopt healthy lifestyles, thereby reducing the financial burden on the health care system.
The Government of Trinidad and Tobago, a country where the number of persons living below the poverty line is still significant (estimated at 17% in 2007), recognizes health as a fundamental human right and sees itself as a guarantor of quality health care services for all its citizens from birth to death. In its noble ambition to provide quality health care free of charge to all who attend the public health care facilities, it is challenged by the escalating costs of modern-day quality health care and a global economic recession. This paper reviewed some of the many factors affecting health care spending in Trinidad and Tobago and took a look at how the future economic needs of the health care system of this small island can be addressed and financed. References
Dookeran, W. (2010, September 8). Budget Statement 2011, facing the issues, turning the
economy around, Government of Trinidad and Tobago. Retrieved from http://www.normangirvan.info/trinidad-and-tobago-budget-2010-2011-documen/
Garrett, T. M., Baillie, H. W., McGeehan, J. F., & Garrett, R. M. (2010). Health Care Ethics: Principles and Problems (5th ed.). Upper Saddle River, NJ: Prentice Hall.
Getzen, T. E., & Allen, B. H. (2007). Health Care Economics. Hoboken, NJ: John Wiley & Sons.
Getzen, T. E., Moore, J. (2007). Health Care Economics: Principles and Tools for the Health
Care Industry (1st ed.). John Wiley and Sons
Index of Economic Freedom (2011). Promoting economic opportunity and prosperity??”a
product of the Heritage Foundation and the Wall Street Journal
National Health Care Spending in Trinidad and Tobago