I am responding to Mr Huey Granston's letter published yesterday on the Government's current policy of free access to public health care.

Health systems have three fundamental objectives - improving the health of the population they serve, responding to people's expectations and providing financial protection against the costs of ill-health. In keeping with these objectives, the Government's decision to abolish user fees was in no way short-sighted but routed in evidence and public opinion.

Access to facilities

The 2007 Jamaica Survey of Living Conditions reported that of the 65.1 per cent of persons in the poorest category that use Jamaica's public health facilities, 50.8 per cent did not access care in 2007 because of an inability to pay.

According to the World Health Organisation, each year 100 million people are impoverished as a result of catastrophic health spending. So while I do agree with Mr Granston that Jamaica's health services have always been provided free, or at nominal costs to all citizens, I think it necessary to bear in mind the macroeconomic environment within which many Jamaicans are forced to survive, an unstable environment which has only grown worse with the recent financial crisis. Should one's demand for, and access to health services, be correlated to one's income?

The direct link between health and productivity certainly does not allow us to take such changes.

Better health outcome

Planning for better health outcomes goes well beyond financing. The United States health care system has shown us that more resources does not equate to better health. Managing for more efficient use of resources is what's important.

Jamaica's health system lacks quality management of processes and systems, including the drug procurement system. There is no shortage of planning for health, but plans cannot be executed without human resources, capacity and stewardship.

The Government's aim for equity is admirable and relevant. However, free access to health must be accompanied by complementary policies that effectively manage for increased utilisation and aim to maximise such utilisation.

I hope Mr Granston can also appreciate that, despite the challenges, Jamaica's health indicators are comparable to those of developed countries.

I am, etc.,

Anya Cushnie

avcushnie@gmail.com

St Catherine