Young professionals debate paid healthcare

The International Health Day was celebrated on Thursday 7 April 2016. Mauritius boasts a welfare state whereby the population benefits from free healthcare facilities. The country has both public and private hospitals. Private hospitals offer paid-for services while public hospitals are free. This week, young professionals debate whether it is advisable to introduce a payment system for public healthcare. During a visit of cardiac surgeons from Pakistan this year, Minister of Health Anil Gayan announced that a formula should be found to make some services become payable in public hospitals.

[[{"type":"media","view_mode":"media_large","fid":"14623","attributes":{"class":"media-image wp-image-24432 alignleft","typeof":"foaf:Image","style":"","width":"179","height":"183","alt":""}}]]Jevin Appadoo: “There should be a public - private mix”

30-year old Jevin works as medical representative for one of the top Indian pharmaceutical companies. He totally agrees with the Minister that there should be a mix of public and private in healthcare facilities. “We often hear people complaining about high prices in healthcare but do we realise how much money is spent on fast foods in Mauritius? Considering the number of patients visiting hospitals daily, if a nominal fee of say Rs 10 (less than the price of a dholl puri) was introduced, it would generate funds which could be used to support running costs.” According to him, public healthcare is mostly financed by tax payers. “A free health system is beneficial to the population as a whole but especially to middle and poor families who might not be tax payers. There tends to be abuses in this system and to prevent same, the healthcare sector needs to be regulated. Patients should be encouraged to visit their local area health centres and only upon referral, to visit the hospital. This could prevent overstressing public hospitals.”

[[{"type":"media","view_mode":"media_large","fid":"14620","attributes":{"class":"media-image wp-image-24429 alignleft","typeof":"foaf:Image","style":"","width":"173","height":"206","alt":"young-pro-asha"}}]]Asha Shibdoyal: “I don’t think such facilities should be payable”

Asha is a software engineer and believes that it is important to know which facilities will be made payable. “Healthcare has always been free and if part of the services will become payable then it does not make sense. Clinics and private doctors are already available. We only have to choose as per our means and services we want. If the services available are improved then perhaps it would be good. Else, with the current situation, I don’t think such facilities should be made payable. The quality of service is already very poor and the process is already very time consuming.” For Asha, it will be bad for vulnerable groups given they can only resort to public health. “If ever it will be payable then I think people from poor and broken families will not bother to give their kids treatment for minor health problems which may at the end develop into complications. These people already have financial difficulties and by paying for health services, they will be more indebted and their situation will worsen. This will widen the gap between the rich and the poor.”

[[{"type":"media","view_mode":"media_large","fid":"14622","attributes":{"class":"media-image wp-image-24431 alignleft","typeof":"foaf:Image","style":"","width":"191","height":"183","alt":"young-pro-himanchu"}}]]Dr Gurbah Himanshu Sharma: “It jeoparadise National Health”

29-year old Dr Himanshu is a dentist. He says that bearing in mind that illness, diseases, accidents and influx of patients in hospitals are soaring, and with the high costs of the treatments required, he understands the ideology of the Health Minister. “We have an ageing population with a decreasing taxpayer base. Those who have the means are already going to private clinics. It sounds strange to go to a government hospital with a purse. It will put National Health in jeopardy. Numerous people already have their deductions and co-payments. Some cannot even afford a square meal. I wonder if they can pay hospital bills.” The role of the government, he says, is to design a way to find a panacea to this issue. “Like sensitising people to take medical/ dental insurance schemes. The least they can do is to make it free for very low income earners. Health must be a priority in any civilised country and Mauritius is no exception.”

[[{"type":"media","view_mode":"media_large","fid":"14624","attributes":{"class":"media-image wp-image-24433 alignleft","typeof":"foaf:Image","style":"","width":"167","height":"173","alt":"young-pro-rizwan"}}]]Rizwan Chumroo: “There should be a mutual commitment”

Rizwan is a physiotherapist and argues that a free health service is no doubt advantageous for a nation but it is always at the expense of a high quality service. “A minimal fee should be applied for every hospital service. The government spends an excessive amount of money to maintain the health system which impacts on citizens in terms of higher cost of living each and every year, along with all the hidden charges. In addition, when the service is payable, abuse will decrease substantially as many people come to hospital just for simple headache or minor pain or it happens that when accompanying a patient they also turn into a ‘patient’.” Rizwan maintains that the working class and poor people will also be able to afford this minimal charge. “When they can spend money on cigarettes, alcohol and different types of gambling, they should also be able to afford a minimal health service fee as good health is the primary concern for everybody. In case of the extremely poor, a system of sponsorship through the National Empowerment Foundation and CSR funds could help to pay their healthcare fees. There should be a mutual commitment of the government, the service providers and the end-users so as to ensure a quality health service for the Mauritian nation.”

[[{"type":"media","view_mode":"media_large","fid":"14619","attributes":{"class":"media-image wp-image-24428 alignleft","typeof":"foaf:Image","style":"","width":"181","height":"176","alt":"najeeb"}}]]Najeeb Ahmad Fokeerbux: “It is simply not permissible”

25-year old, Najeeb is a technical officer and argues that healthcare and access to health is a basic human right. “As part of total health expenditure, private healthcare and public healthcare were almost 50:50 in 2013. In this cohabitation between the public and private setting, Mauritius is doing well as compared to other African countries. However, too often, we hear complaints about the quality of service. When healthcare is a basic human right, it is simply not permissible to make public healthcare payable even for part of treatments.” As highlighted by him, people who can afford health insurance and private healthcare are already doing so. “In a society becoming bipolar in terms of social classes, having a growing low and high-income groups, with the middle class disappearing, partially paid public healthcare will place an undue burden on the poor, the marginalised, the unemployed youth, women, disabled persons, elderly persons, and many more. State investment in healthcare for the well-being of its population is an investment in its human resource for better productivity, promoting human rights and dignity and being more competitive economically.”

Hityeshita Devi Maghoo: “The quality gaps take many forms”

21-year old Hityeshita is an entrepreneur and a graphic specialist. According to her, it is widely acknowledged that health systems of all types suffer from gaps between best practices supported by evidence and the actual delivery of health services. “Many of these quality gaps are readily amenable to improvement, yet they persist in spite of increased levels of health expenditure and numerous other reforms in healthcare financing, regulation, and service delivery. The quality gaps take many forms; including failure to implement evidence-based clinical practices, fragmentation of services, slow and incomplete responses to adverse indications, and lack of attention to appropriate preventive measures.” For her, with the government rallying to shift the system from a publicly funded healthcare system towards a paid system, the impact of this strategy can be two-fold. “As citizens of Mauritius, we acknowledge that our healthcare system is complex, yet up to international standards. We have one of the best healthcare services in Africa, but at what price? It consumes a significant portion of our National Budget. In a difficult economic setting, shifting towards a paid system might ease finances.” Hityeshita argues that several abuses in the past have been flagged and as a corrective measure, we can argue that this payment system would surely minimise wastage. “Converting our system directly to a paid system may not be controllable, however, implementation of the project in phases from a single payer system to a distributed system and sharing the health care expenditure with private insurance may have more impact. However, whatever be the case, vulnerable groups should be given due consideration.”

[[{"type":"media","view_mode":"media_large","fid":"14621","attributes":{"class":"media-image wp-image-24430 alignleft","typeof":"foaf:Image","style":"","width":"179","height":"199","alt":"young-pro-deegesh"}}]]Deegesh Maywah: “How will vulnerable citizens adapt ?”

27-year old Deegesh Maywah is a lecturer and maintains that increasing value for money in health spending is a common challenge for all countries. Quality and service delivery can improve, and there are significant gaps between care delivered by practitioners and best practices as they are defined by widely accepted standards and guidelines. For him, the strategy has some serious impact on the culture and demographics of the country, as for decades, Mauritians have been able to enjoy free health service, resulting in higher life expectancy. “Now with this new system, will Mauritian culture adapt to the changing course of the global health agenda? How will vulnerable citizens adapt to this new service?” To conclude, Deegesh strongly believes that prior to change the single payer Healthcare system, we should stress on the implementation of the Citizen Charter of Mauritius first, rather than jump directly on a payment system.