Despite the introduction of a system which has facilitated access to the public health-care system by the vast majority of Jamaican people a recent series of articles in your publications seemingly points to a system in dire straits. However, maybe some facts need to be pointed out. I speak from a somewhat privileged point of view as my father is a senior medical practitioner and I count as friends several members of the medical profession.

First, I would like to point out that the cost to the Government of removing user fees is necessarily balanced against the very human cost of the lives saved by the removal of these fees. The cost to human dignity of being turned away from the hospital because one cannot afford the monetary cost of health service is too much to bear for many people. The shame of going to the desk at the Kingston Public Hospital and the nurse telling you to come back with the $5,000 to do the 'likkle surgery' does no one any good.

Major problem

Second, it would appear from the articles that one of the problems in the increase in users seeking to access health care may be boiled down to hospitals providing a more effective screening process.

There is little a government can do to prevent hypochondriacs from trying to pressure health officials, but it is incumbent on those health professionals to turn the persons away. It is not unusual and indeed should be an obligation to remove from the secondary and tertiary system (where most of the new stress seems to be) those persons who obviously do not need health services immediately.

Third and probably most important, I believe these articles do not take into account the full benefit to the society of having a population that is fit to work. Several studies have been done to this effect. A useful article setting out the merits of universal health care which is what the government policy is about may be found at http://www.amsa.org/uhc/CaseForUHC.pdf .

I am, etc.,

ROBERT C. St. C. COLLIE

robert.collie@mfg.com.jm

Kingston, Jamaica