Jamaica is in a position to learn from more advanced nations with regards developmental policy initiatives. Developed nations provide models that would eliminate the need for policy experimentation in developing countries, in which the worst social policies and mistakes can be discarded, while the best practices are implemented by the Third World.
Unfortunately, even though Jamaica has this opportunity regarding development, user fees for health services were still abolished, without first realizing the necessary changes to make this policy sustainable.
The policy has ostensible benefits in providing assistance to disadvantaged groups such as the elderly, children and those suffering from below subsistence-level poverty in general. However, Jamaica does not have the resources or the necessary characteristics for health care services, including medication to be offered without fees as a long-term sustainable practice.
Countries that provide sustainable health care without fees have the demographics and population structure, ideologies, social structures, human resources, tax base and infrastructure that are conducive for such services to be offered without a charge.
The population characteristics of these rich nations include: a high educational attainment, high income, low birth rates, and low rates of violence. Jamaica is offering health services without fees without these necessary economic and social structures. Under the present circumstances, Jamaica does not have the necessary tax base to provide such services.
More importantly, it must be recognized as a general principle of demographics that the relatively low educational attainment, low income, high unemployment, high birth rate, and a high rate of violence of Jamaica are not conducive to a sustainable health care system without fees. High levels of violent crime and poverty significantly undermine the physical and psychological health of a population, which can cripple a free health care system.
Access to health care is often considered a human right, rather than a privilege in the developed world. However, even these wealthy nations that can afford to offer health care without fees debate its merit due to excessive costs and massive government debt.
Some aspects of these health care systems are even being re-privatized because of: excessive wait times, waiting lists, higher taxes, higher user rates due to lack of discretion in using the services that are deemed free, decreased quality of service, and lack of available medical staff. These issues have always plagued the Jamaican system, and will only be exacerbated with the new system.
Moreover, it is important to highlight that the concept of health care as a right, (along with most ideas in the developed world) was established after these nations already attained the wealth, infrastructure and culture for such policies to be implemented.
The Jamaican economy needs to be restructured before election campaign promises that are made to attract votes are actually implemented to the detriment of the nation’s development. It may be a well-intentioned policy, but not one that the country can afford at this time.
An example of a more sustainable approach would have been to earmark all revenue for health care services for several years to the purchase of state-of-the-art crime scene investigation technology, personnel and training, which may reduce the violent crime and murder rate (as evidence could be gathered to convict perpetrators with less reliance on unwilling witnesses.)
This will not only improve the physical and mental health of the nation, but also improve the business climate and economic plight of the nation. This in turn will reduce unemployment, and improve the tax base to ease the eventual implementation of a free health care system.
There is a need for more strategic planning for development, rather than just blindly implementing the ambitious goal of free services for all, while hoping that the means of achieving the goal will just work itself out in the process.