Jamaicans are woefully under-insured, representing a serious chink in our armour in the fight to preserve public health against the onslaught of non-communicable diseases (NCDs), including hypertension, diabetes and cancers.
Seven out of every 10 Jamaicans die from a NCD. In 2015, 24 per cent of those deaths were premature, occurring in individuals between the ages of 30 and 70 years old. With only 20 per cent of the population having health insurance, our current struggle with NCDs is like staring down the barrel of a gun, with no option for fight or flight.
The lack of insurance means that too many people – including the poor and vulnerable, as well as that burgeoning group of persons referred to as the ‘missing middle’, who are caught between the high cost of private health insurance and the long wait times associated with public services – are denied access to timely medical care, given the financial burden to them and/or their families.
In 2016, 32 per cent of Jamaicans reported that they did not access care when needed due to financial reasons while World Bank data (2011) reveals that the average Jamaican with a NCD allocates a third of the household income (J$55,503) to health care.
This is not a situation we can allow to persist, not when the Jamaica Health and Lifestyle Survey (2016-2017) tells us that one in three Jamaicans 15 years and older have hypertension while four out of every 10 people with the disease are unaware that they have it. One in every eight Jamaicans has diabetes while four out of every 10 are unaware of their status.
Further, as a group, cancers were the second leading cause of death among women and the third leading cause of death among men, accounting for some 21 per cent of all deaths in 2010. The number of new cancer cases for 2018 is estimated at 7,348 for both men and women, and include prostate, breast, lung, and cervical cancers, according to Globocan data.
Whether it is the failure of private insurers to offer enough diversity in their offerings or the ‘free health care’ mantra that has caused many of our people – one in two of whom are overweight or obese, which is a known modifiable risk factor for developing a NCD – to become complacent, the lack of health insurance among Jamaicans is an issue we must tackle.
The truth is, while we continue our advocacy for preventive health care through efforts such as Jamaica Moves, Restrictions on Sugar-Sweetened Beverages in Schools and the Taking Responsibility Road Tour, many of our people are already living with NCDs while numerous others are at risk of developing NCDs. It means that, of necessity, mechanisms must be put in place to help assure them of access to quality care and the effective management of such illnesses.
It is against this background that we are developing a National Health Insurance Plan, toward the provision of universal access to health care, which is premised on a number of factors. These include that no-one should be denied care because of an inability to pay; augmenting service delivery with private and NGO sector partnerships; and multi-sectoral collaboration to address the social determinants of health.
The National Insurance Plan now being developed takes account of all of these factors while being crafted to recognise the need to be complimentary to public network and to private health insurance coverage; target the highest impact services that will impact health system goals; and allow for the gradual strengthening of the public system. This is all to ensure the best possible health outcomes for our Jamaicans, who will need to see value in taking responsibility for their health and contribute to the scheme.
I challenge private insurers to prepare for the eventuality of that national plan and to look more closely at ways in which they can boost the Jamaican appetite for insurance. This includes a re-examination of options that can increase health care quality and decrease costs through, for example, the use of financial incentives to promote cost-efficient health care services and influence consumer choices. It is essential, too, that regulators do their part in ensuring the necessary enabling environment that will help to give wings to new and diversified insurance offerings.
The fight against NCDs can be won, but not by a single Jamaican; we all have a role to play – from taking stock of our individual health status to putting in place health policies and programmes, and the provision of insurance options from which people can meaningfully benefit, allowing them to lead healthy, productive lives.
– Dr Christopher Tufton, Minister of Health