Youth debate: Nominal fee for health care

Health care has always been in the frontline in Mauritius. In the recent National Audit Report, it has been observed that there are lots of wastage and abuses in this field. The Mauritian government has been investing massively in the health care sector over the years but still it faces lot of criticism. Often we wonder whether a nominal fee should be applied for health care.  

Yaadav Damree: “A nominal fee should be introduced”

The health care sector is a very sensitive matter affecting everyone’s life, states Yaadav. “Nowadays, many Mauritians opt for private hospitals despite the fact that these are very expensive. Mauritians are fortunate to have access to free care as compared to many other countries. However, the quality of good treatment leaves a lot to be desires. Thus, a nominal fee should be introduced to have a control over the matter. The government spends a huge amount of money to maintain the health system. There tends to be a lot of abuses and to prevent those, our healthcare system needs to have some modifications. When the service is payable, abuses will decrease substantially,. This will certainly increase the quality service of our public hospitals. The working class and poor people will also be able to afford this nominal charge, as it will be very cheap.” 

For him, our system is complex but the health budget consumes a significant portion of our National Budget. “A nominal fee would generate funds which could be used to support running costs of the health care system. This might bring more facilities to the treatment patients will receive, which can be the same as those in private hospitals. The only controversy is that poor people might  find this nominal fee difficult to afford, and for this issue, a special scheme for them can be implemented. To ensure a quality health service for Mauritians, it is important to know about the problems citizens face every day at the public hospitals and a nominal fee may surely help in dealing with those issues.” 

Deegesh Maywah: “Why not introduce a new system” 

With the changing global health agenda and in a limited resources setting, governments and policy makers are struggling to introduce a fee for services in the health care delivery system, says Deegesh.  “The 21st century challenge for health care delivery system is to deliver higher quality care for less money.   Numerous scholars and health care experts agree that payment reform involving transitioning from fee-for-service to global, value-based systems is necessary for us to achieve that goal.  Access to basic health services of acceptable quality is still denied to many of the world’s poorest people. Against a backdrop of severely underfunded health systems, governments are faced with a dilemma. Payments for health services, in the form of user charges, are likely to present a barrier to access. Yet, a shortage of resources at the facility level is a contributor to failure to deliver quality services, and this also presents a barrier to access. Some have argued that user charges can generate vital resources at the local level and help provide good quality services; others have highlighted their negative effects, particularly on equity; recently, several international campaigns have advocated the removal of user fees, especially for primary care services.” 

He argues that in global health care, there are predominantly two models that are usually followed: 1) Fees for Service (FFS) and 2) Pay for Performance (PFP). “Moving away from FFS towards pay for performance introduces quality and efficiency incentives instead of rewarding quantity alone. In the different states of the United States, it has been noted that several health care delivery and health care systems serve as coordinated/integrated care alternatives to the FFS model like South Central Pennsylvania’s Geisinger Health System, whose physicians, residents and fellows are paid a salary with the potential for bonuses depending upon patient performance, Utah’s Intermountain Healthcare, the Cleveland Clinic, and Kaiser Permanente. Coordinated care can produce cost savings of about 50% when compared to FFS programs, but long term savings for payers may not exceed 40%. In China, on the other hand, where FFS resulted in costly, inefficient, and poor quality health care with degeneration in medical ethics, reforms have been initiated to realign health care provider incentives. Experimentation with new payment models is undergoing and recommendations include a strengthening of medical ethics, alterations to provider’s profit motives, and, if hospitals retain their profit motive, segregating physicians from the goal of profit.”

According to him, introducing the concept of Pay for Performance in our Mauritian health care system may not be politically wise for Governments, however, from an economical and preventive aspect for quality care, Mauritians may consider to adopt the pay for performance in our hospitals. “To avoid any discrepancy, adopting the Pay for Performance model, independent accountable care organizations need to be established to ensure appropriate quality care is given. Furthermore, this approach may prevent public outcry and ensure that the general public is aware of the main and holistic benefit for this “preventive” policy. For sure in the long run, Mauritius will benefit from this model.” 

Avinash Dhondoo: “A nominal fee will significantly improve health care”

Avinash argues that the health care system is beset with numerous problems but the most pervasive one is inadequate resource mobilization which includes inequitable and inefficient usage of the existing resources. “Unfortunately the poor and other vulnerable sections of society are the ones these shortcomings hit the hardest. Having a nominal fee will significantly improve health care delivery and consequently service utilization through such things as increased salaries to health facilities staff as well as increasing operational costs. However, this will not benefit everyone in the country. The fact that health care is basic human rights for a person, people shouldn’t pay any fee for it. It’s true that a lot of money is spent every year in the health sector and government will have to generate revenue to continue financing this sector, but Mauritians, rich or poor, should have access to the health care he or she needs. Mixing business with medicine will inevitably lead to abuses that violate patient dignity.”

He further adds that “in a system of for-profit health care, doctors will become subject to the control of lay managers accountable to share-holders whose primary aim is making a profit. Such hospitals will encourage doctors to promote profit-producing drugs, surgeries, tests and treatments. Furthermore, as for-profits come to dominate the health care sector, society will suffer a severe shortage of unprofitable, but critical, services, such as emergency rooms. Meanwhile, scarce resources will be squandered to produce and aggressively market lucrative, but unnecessary, services, such as cosmetic surgery. The virtues of caring, compassion, and charity, and a sense of community have guided their decisions about the range of services to provide and the kinds of research or education to support. The ideal of altruism has been perpetuated by physicians whose primary concern has been the alleviation of human suffering and the restoration of health. Society must not allow such important and fragile virtues and ideals to be extinguished by the self-interest that drives for-profit enterprise.”

Darshan Agileswaran: “Health care is a major business”

Today, health care is a major business to the corporate world along with its adequate evolution in technology, states Darshan.   “A nominal fee for health care has its pros and cons.  In Mauritius, introducing a nominal fee depends on the degree of the illness and the quality of service provided by government health institutions. A nominal fee should be accepted by government hospitals for certain serious types of diseases like diabetes, cancer or hypertension, for which patients have to be treated as long as they live. On a humanitarian ground, a nominal fee should not be accepted in case of emergency cases like accidents since the life of a person is at stake. On the other hand, in Mauritius most people who are categorized as from upper-middle class prefer services from private health institutions.  This culture should be reduced by improving the services in the public hospitals. Government should upgrade hospitals to ensure that good services are provided. In this context, a nominal fee for health services should be accepted to ensure good services and further major development in the health system of the country.”

Manoubhavna Koonja: “Equal opportunities for all people” 

Taking into reference the Universal Declaration of Human Rights (UDHR) that everyone has the right to a standard of living adequate for the health and well-being of himself and that of his family, Manoubhavna believes in bringing a comprehensive welfare state. “A government should definitely provide health care to all his citizens. There should be equal opportunities regardless of race, religion, or class and to secure a healthy lifestyle for future generations. When people are strong and healthy, they will certainly contribute to a better workforce. We need to support people in our country as best as we can. Mauritius is a well-known destination and is mostly appreciated by tourists for its natural beauty and man-made attractions, multi-ethnic and cultural diversity of the population, tropical climate, beautiful beaches and water sports. If we can’t find a way to take care of our sick, other countries will take notice and this will backfire on us, and our economy will nosedive.”