Can a re­gion­al health in­sur­ance scheme that al­lows cit­i­zens of Cari­com to ac­cess care in cen­tres of ex­cel­lence in the re­gion work? Well this is one of the ques­tions be­ing con­sid­ered by the Pan Amer­i­can Health Or­gan­i­sa­tion (PA­HO) and Cari­com as they try to find so­lu­tions to the chal­leng­ing health sit­u­a­tion in Cari­com and a sus­tain­able way to fund­ing re­gion­al health­care.

Ear­li­er this week, the re­gion marked the 49th an­niver­sary of Cari­com Day, recog­nised on Ju­ly 4 each year. Since the Treaty of Ch­aguara­mas was signed in 1973 by Prime Min­is­ters Er­rol Bar­row of Bar­ba­dos, Forbes Burn­ham of Guyana, Michael Man­ley for Ja­maica and Dr Er­ic Williams for T&T, the Caribbean Com­mu­ni­ty has col­lab­o­rat­ed on many ini­tia­tives over the last five decades. The next big project could be health.

Rep­re­sen­ta­tives of the Pan Amer­i­can Health Or­gan­i­sa­tion (PA­HO) flew in­to T&T last week hold­ing sev­er­al meet­ings with lo­cal of­fi­cials from the Min­istry of Health and the Uni­ver­si­ty of the West In­dies. One of the top­ics dis­cussed with the health min­istry is health fi­nanc­ing. The Pri­ma­ry Health Care Per­for­mance Ini­tia­tive sim­pli­fies this of­ten com­plex term as “to how fi­nan­cial re­sources are used to en­sure that the health sys­tem can ad­e­quate­ly cov­er the col­lec­tive health needs of every per­son.”

The av­er­age cit­i­zen in T&T pays ap­prox­i­mate­ly 47 per cent of the to­tal ex­pen­di­ture that is be­ing spent across the health sys­tem. In the Caribbean, pub­lic spend­ing on health ac­counts for ap­prox­i­mate­ly 54 per cent of all health ex­pen­di­tures, on av­er­age.

Dr Guiller­mo San­doval, tech­ni­cal di­rec­tor, Health Fi­nanc­ing at PA­HO broke it down fur­ther. He said, “Out-of-pock­et is re­gres­sive. It af­fects the poor, the vul­ner­a­ble and those with chron­ic con­di­tions be­cause they need to seek more care. If they have to seek more care and they have to pay out-of-pock­et, they might hes­i­tate be­cause they don’t have the mon­ey to pay for the ser­vices. If they can­not do that be­cause they need to pay for oth­er ba­sic ne­ces­si­ties, they will de­lay care and as a con­se­quence they will have worse out­comes, and even­tu­al­ly, in the ag­gre­gate num­bers, mor­tal­i­ty will be low­er in those coun­tries where out-of-pock­et is high­er.”

Dr San­doval went fur­ther in ex­plain­ing to the Busi­ness Guardian that the re­la­tion­ships as­so­ci­at­ed with health fi­nanc­ing can be very com­plexed and in­volves the gov­ern­ment, em­ploy­ers, in­for­mal sec­tors, the con­cept of sub­si­dies for those who can’t af­ford and pri­vate health in­sur­ance.

“At the end, what we want is to ad­vance uni­ver­sal ac­cess and cov­er­age,” he said.

In coun­tries where the health sys­tem was al­ready com­pro­mised, the pan­dem­ic has made health fi­nanc­ing even more crit­i­cal.

Dr San­doval fur­ther ex­plained, “Pub­lic fi­nances or pub­lic sources is the largest source of health fi­nanc­ing in any coun­try so if gov­ern­ments are now stacked with tons of debt, they can­not con­tin­ue fund­ing or ex­pand­ing or even re­new­ing the health­care sys­tem so the fact that the economies were im­pact­ed se­vere­ly; it means less mon­ey for gov­ern­ments and it means less mon­ey for health­care. That is the im­pact we saw with the COVID-19 pan­dem­ic.”

This is where a col­lab­o­ra­tive ef­fort be­tween Caribbean coun­tries can make health­care more eas­i­ly ac­ces­si­ble for its cit­i­zens. Dr San­doval ad­mit­ted con­ver­sa­tions sur­round­ing a re­gion­al ap­proach or a re­gion­al health in­sur­ance mod­el have been on­go­ing “for some time now.”

While he says it will not cov­er all health­care ser­vices, it can start with the most crit­i­cal con­di­tions, es­pe­cial­ly treat­ing pa­tients who can­not be helped in a par­tic­u­lar coun­try. “This could be tied with a cen­tre of ex­cel­lence where you fo­cus a vol­ume of ser­vices in cer­tain ar­eas and as a re­gion we come to­geth­er and pro­duce some sort of in­sur­ance mod­el that all coun­tries can par­tic­i­pate in or­der to make it ef­fi­cient and then with that mod­el we can cov­er ser­vices that are not cov­ered in a coun­try,” Dr San­doval ex­plained.

Such a ven­ture will re­quire po­lit­i­cal will across Cari­com. If Caribbean na­tions are to align them­selves with this mod­el, they will be re­quired to par­tic­i­pate in fund­ing it, which of­ten re­quires some to take on a larg­er bur­den than oth­ers.

How­ev­er, di­rec­tor, sub­re­gion­al pro­gramme co­or­di­na­tion Caribbean, Dean Cham­b­liss, said the frag­men­ta­tion of the health­care sys­tem doesn’t help the re­gion ei­ther.

He em­pha­sised, “There is no com­pre­hen­sive and co­her­ent strat­e­gy to pro­vide health ser­vices to the pub­lic.”

Cham­b­liss added sus­tain­abil­i­ty of health fi­nanc­ing is an­oth­er key ques­tioned that must be an­swered. “There are many dif­fer­ent sources of fund­ing to pay for health ser­vices. The gov­ern­ment is a ma­jor one, cer­tain­ly in­di­vid­u­als, cer­tain­ly or­gan­i­sa­tions can help to pay for health fi­nanc­ing as well so look­ing at how we pool to­geth­er these re­sources and use them most ef­fi­cient­ly is a key as­pect of health fi­nanc­ing and one way to re­duce bar­ri­ers,” Cham­b­liss said.

Com­ing out of the pan­dem­ic, Dr San­doval says health fi­nanc­ing is an im­por­tant step. “I think it’s an im­per­a­tive and it has to be done as soon as pos­si­ble be­cause trans­for­ma­tion takes a lot of time and in the mean­time peo­ple are de­lay­ing their care which means they are at risk of worst out­comes in­clud­ing ex­pect­ed life ex­pectan­cy,” he stat­ed.