The future of Health Care – Part 3 of 3

by Dr Jerrol Thompson

(Last week, in two articles in Searchlight (Nov 17 and 20), I discussed critical health problems inherited by the ULP in 2001 and discussed eight of them in depth. In this, the third and final part of this article, we look at the new state-of-the-art hospital the ULP intends to build.){{more}}

The new state-of-art hospital: The ULP will build a new state-of-the-art hospital on 7-8 acres of the 65 acre Arnos Vale Airport site, providing a high level of professional, specialized care and new services, including cardiology, neurosurgery, kidney disease and cancer care, etc. Terms of reference (TOR) have already been developed for the detailed designs of this Acute Specialized Referral Hospital through World Bank funding. Designing a hospital is a highly specialized task and serious business requiring 21st century standards and regulations and cannot be done willy-nilly by anybody. I will not comment on any concept designs extracted from Farmville; this is puzzling, but it raises serious questions which the NDP must answer. (a) Firstly how can the NDP propose the cost as EC$75 million, for such a new 150-bed stand-alone facility, when the standard cost is EC1.2 million/bed?

The ULP’s 130-bed Acute Referral Hospital will be the flagship facility within a network of wellness centres (and a separate Mental Hospital and Pediatric/Children’s facility remaining in Kingstown) will cost between EC140 to EC150 million, twice the NDP cost. (St Lucia just completed a new national hospital at a cost of EC$ 189 million, which includes several units in an all-in-one facility). Clearly, funding will be very challenging, but Daniel Cummings made me laugh out loud when he stated that he will depend on Eustace to find the resources. (b) Now, after the successful experience of financing the AIA, who do you think is more likely to pull together the funding, Eustace or Ralph? (Do you recall Eustace’s “Find it Where” and “Ask Ralph”).

With the logical, approach of using a World Bank funded study to determine the best location for its construction and the Arnos Vale site deemed the best site in a detailed study of six possible locations, the ULP is well on its way to secure funding. However, the study did not include Calliaqua, or any location in East St George. It did consider a location at Diamond in South Windward (as no suitable location was available in East St George, as suggested). What is clear, Eustace and Cummings will avoid publicly stating Arnos Vale is the best site at all costs. (c) So, where is the site for NDP’s hospital?

NDP has said if they mention the site it will be prone to speculation and more difficult to acquire. Now this is very revealing, as it suggests NDP will buy 6-8 acres of land and homes in one of the most expensive real estate markets on the mainland when Arnos Vale Airport is already Government owned. (d) So why buy land for millions and waste precious money when you already have 65 acres? Who will be so lucky? Lastly, questions must be raised on transparency i.e. (e) Is Stewart Engineering working for free, or how much will they be paid for the designs. Would designs be still tendered out, or was Stewart given this as a gift and would the designs be applicable if the site was moved to Arnos Vale? Further is this the in-transparent manner Arnhim plans to govern, just telling a friend to write your own TOR, do the mock-up designs and send us the bill? These are all mute, but unanswered questions as the ULP will remain in government and accomplish its Health Care and Wellness Revolution.

10. Financing and National Health Insurance: Currently the Government spends over $64 million on health; however, due to certain policies and constraints, Government only collects less than five million in revenue, through stamps and fees, of which only 1.2 million is through the MCMH. For a fully functional health care system with all its integral parts, polyclinics; converting part of MCMH to a World Children Facility with the new state-of-the-art Pediatric Unit, the new Mental Hospital and new Acute Referral Hospitals, all the additional staffing and new specialist, a whole range of new services, adequate medication and supplies integrated in a new governance, administration and emergency management system will likely have a recurrent cost in excess of 80 million annually. This does not include the capital costs.

Currently, the NIS already collects 59 million dollars just from deducting 10 per cent of workers’ salaries for NIS benefits. (Total wage earnings in SVG is EC$590 million). If an additional one per cent (1%) deduction is taken from the current 30,000 – 35,000 workers’ salaries, it will only raise a mere 5.9 million dollars, still leaving a deficit of 60 million. In fact, an unreasonable and intolerable additional 12 per cent in salary deduction will be required to fund the current $64 million cost of health care, much less the expansion that is required. In 2003-6, the ULP Government went through a lengthy process and re-engaged consultant Dr Karl Theodore (Trinidad) to review the planned implementation of National Health Insurance. Even at that time, one per cent was considered inadequate and any higher percentage salary deduction was considered far too unbearable for workers and Unions who were likely unwilling to pay, as the majority of Vincentians, children, the elderly and physically challenged would be exempt. Soon after the financial crisis of 2008, it was decided to postpone implementation of National Health Insurance until some degree of economic recovery and other improvements were put in place. No other OECS country has been able to implement National Health Insurance because of the huge deficit in health revenue. Barbados does not have National Health Insurance, but deducts 21 per cent for unemployment benefits. Belize and the Turks & Caicos Islands have challenges even with a limited Health Insurance service. However, even with a one per cent deduction, the Government will have to find additional ways to adequately finance the huge gap in financing modern health care.

So, in surmounting the 2001 challenges and old antiquated health care left by the NDP, the ULP’s approach was starting an aggressive, but step-wise Health and Wellness Revolution. We have already virtually accomplished major successes in solving nurse, nursing assistant and specialized physician shortages through training; the long Casualty wait solved by constructing polyclinics and improved rural hospitals to smart hospitals with doctors’ quarters. We will soon solve the shame and disrespect of our mentally ill brothers and sisters with the new Mental Hospital at Glen. The basic public health issues of sanitation, water, electricity and garbage disposal have essentially been solved, bringing much acclaim to SVG and the targeted plan to address the growing worldwide challenge of hypertension, diabetes, etc is well underway.

With the Diagnostic Hospital in GT, the system of smart energy efficient hospitals, CT-Scan, ICT and other new equipment will significantly improve the speed and accuracy of diagnosis. Specialized services like the state-of-the-Art Pediatric Unit opened early this year with its growing international support as a regional hub; the site for the new state-of-the-art Acute Referral (Specialized) Hospital already selected after careful study, on land we do not have to buy and will become a focal point of the new city at Arnos Vale, with all facilities linked by a new EMS-Ambulance service

However, with the challenging issue of health care financing, the people of this nation must be treated with honesty and respect. The NDP should not try to fool this nation that a one per cent deduction from salaries will solve all our financing problems. A one per cent will only raise a similar revenue to what we currently collect today. Because the Unions and citizens and workers may be unwilling to accept larger deductions, Government’s current finances of 92 per cent of the current $64 million cost is likely to increase with the planned expansion and new services and it will still be required to finance a lion share. The $75 million cost of the NDP hospital is a big joke. However, where would Eustace find such financing? Certainly not PAHO? As we have already accomplished so much in this step-wise Health Revolution journey, in order to go the full distance, we will need other innovative forms of finances to bridge the health financing gap and provide sufficient funds to pay for even more new staff, purchase medications, supplies and the innovations.