Too much PR in Life Fund
IN the previous column I reaffirmed the critical and crying need for the establishment of a system of national health insurance in this country so that all citizens can be in a position to have access to an acceptable level of health care in the light of the significant deficiencies in the public health care delivery services.
There are a few privately funded health insurance schemes but unfortunately only a very small proportion of the population is covered by them. What is urgently required is health insurance for all but this is not being addressed because our priorities are skewed.
Of late, the Children’s Life Fund has been initiated. I have stated that it is a laudable venture to the extent that some children in desperate need of more advanced and costly procedures can indeed have speedy access to funding. But let us put the operation of this fund in some national perspective.
It seems that the volume of public relations associated in promoting the fund is out of all proportion to the benefits to be derived under it. In any given year, perhaps twenty or thirty needy children may obtain financial relief through this fund. But then there may be thousands of others who, for one reason or another, are not able to have access to the fund and have to rely on the financial resources of their families, such as they may be. In addition, the fund is not a public financial resource but a private one, the administration of which has not been transparent including the criteria utilised for granting awards from the fund. How are we to confirm that the most deserving applications are accommodated and that contact and the request of friends, relations and clients of the senior members of the administration are not the significant consideration in making decisions?
Juxtaposed to the reality of the miniscule number likely to benefit under this much-propagandised fund is the agonising experience of the thousands of middle and lower income families who are financial vanquished by the illness of some member.
As the name suggests, National Health Insurance is in the nature of a pooling of resources to which all are required to contribute including the government. In addition to subventions, the Government would also undertake to meet the premium payments of those unable to do so, such as children, the aged, the infirm, the financially challenged and the chronically unemployed. The objective is to guarantee coverage to all. The system has to be compulsory and the participation of all mandatory. In this regard the health surcharge currently levied has to be eliminated. This is a misnomer since this surcharge is really in the nature of general taxation and not targeted to the funding of the public health care system. It is merely a revenue generating measure and in any event the total collected under this heading is a relatively small amount.
As in any insurance system all are required to contribute but not all will have the need to access health care to the extent that some will be forced to due to the ongoing health problems encountered by such individuals. But all will have access in case of need. The institution of a system of National Health Insurance will have economic advantages, as it will guarantee better health care for all and thus result in a healthier and more productive population. In addition, it will denote a more caring and compassionate society and one which promotes equality if only in relation to health care access. And it will relieve the gnawing sense of financial and emotional insecurity that descends on families when members become ill.
There are significant issues to be resolved before a system of National Health Insurance can be put into effect and I am not suggesting that these are not complex and challenging. The technical issues relate to the terms of the actuarial analysis which takes into account the age categories of the population and their respective health profiles, the various levels of families’ income earned, the extent of health care coverage considered desirable and the gradations of contributions from employees, employers, the self-employed and those earning income from investment. The composition and terms of reference of the independent authority charged with the administration of the system will have to be given careful thought as well as the contractual relationships with health care providers and the regulation of cost and quality of health care provided. Since there will be no distinction between the public and private health care system, all health institutions and practitioners will be required to bid and compete to provide the various categories of services in which they have competence on the basis of criteria laid down.
(To be continued)
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