est. 2007

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Demystifying Government’s Healthcare Policy

Submitted by Trained Economist

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Minister of Health Donville Inniss

Over the past few months there has been much discussion and media coverage of issues related to health care policy in Barbados.  Despite the volume of media coverage I remain unclear as to a number of issues, which  restricts my ability to adequate assess the health care policy issues being raised.

From what I have been able to glean there are three issues out there:

  1. Only nationals and permanent residents are now entitled to free health care in Barbados.
  2. Persons eligible for free medications who choose to purchase such medicines at a private pharmacy are now required to pay the processing fee charged by the pharmacists to public patients and previously paid by the government.
  3. A number of changes have been made to the drugs on the formulary and medicines previously available free of cost are no longer available free of cost.

I would like some clarity on the following issues:

  1. Was residency status ever a requirement  for free health care in Barbados?  If so what residency status entitled a person to to free health care ?  The answer I am trying to get at here is whether or not we have a change in policy or enforcement of a previously existing policy?  Some follow up questions from a serious media outfit trying to inform its readers and/or listeners on issues, would be , why was the policy changed if it was in fact changed?  If there has been no change in policy, why was the policy not previously enforced and why is it now being enforced?  I am sorry, but I expect half decent journalists to seek out answers to these questions  if they are running stories on an issue.
  2. What is the purpose of the processing fee for public patients at private pharmacies?  Is it a fixed fee, a sliding scale or what?  How much is the fee?  The answer  am trying to get at here is why are the private pharmacies charging a fee at all for public patients, and how much  the government is saving by introducing a measure that will clearly generate some degree of inconvenience and or cost to persons.   Is the tax payer being fleeced by the private pharmacies?  Is the government being penny wise and pound foolish?  Is the policy change likely to impose a major financial burden on public patients choosing a private pharmacy? I am amazed that no such questions were posed to the Head of the pharmacy body quoted at length in a front page story in one section of the media on Sunday May 29.  As  a lay person reading that story the solution for the private pharmacists seemed obvious to me.  Wave the processing fee and get back the business.   I am sure I am way off base, but despite massive coverage of the issue I am unclear on a number of relevant issues.  I am sorry, but I expect half decent journalists to seek out answers to these questions  if they are running stories on an issue.
  3. Are there brand name and/or  generic alternatives available under the formulary to the drugs removed recently removed from the formulary? How many such alternatives are there in most cases?  Are there conditions previously covered from which there are no drugs on the formulary?  How much money is the government expecting to save from the changes to the formulary.  Even though I am personally inconvenienced I accept that you cannot run a free drug scheme without taking  advantage of opportunities to source drugs at a lower cost.  Alternative drugs don’t work well for everyone, but the answer I am trying to get at is whether or not patients have at least two or three alternatives to the drugs removed from the formulary?  Are doctors and pharmacists making patients aware of these alternatives (if there are any).  I am sorry but I expect half decent journalists to seek out answers to these questions and publish them if they are running stories on an issue.I mean despite all the coverage and discussion there has not been a single story about the merits of generic versus brand name drugs.  The newspapers and call in programs are not serious.

I am really disappointed in the media coverage of this most serious and personal of issues.  Health care is not an issue to sensationalize or focus on headline grabbers.  It requires some serious thought and discussion.  I am at the stage where I wonder what is the point of buying a paper.

181 responses to “Demystifying Government’s Healthcare Policy”

  1. Enuff Avatar
    Enuff

    Someone need to call the Ayshford Bird Park or the Wildlife Reserve for this programmed parrot posting under the nom de plume “Just Only Asking”.

  2. Cinnamon Avatar
    Cinnamon

    I went to the Meeting last night, thought the Minister handled himself very well. I was looking for some “fire” from the audience but it never materialize given all the coverage by Sanka Price and others at the Nation in additon to the call-in programs. Just goes to show, it is probably the same people complaining all the time. Even though I think the Minister should follow through to offer assistance to the seniors and those less fortunate.

  3. Just Only Asking Avatar
    Just Only Asking

    @Cinnamon

    You were absolutely correct. The minister handled himself well. The plot backfired. The Minister had his research material with him that is why he could reference certain articles. I am sure the proramme robots realized the script that was writtten for the rabblerousers was defeated and a lot of people left with their heads bowed

    Policy ADVISERs will always ensure that their Minister is armed with the truth to deafeat propoganda. Further, I agree with you that he should follow through on his promise and he has no choice but to do so.

    Congratualions Minister for a job well done and continue your reform of the health services and be mindful that change is not an easy exercise as those who have a vested interest will try to undermine your efforts, but in the end, good always prevail over evil.

  4. Observer Avatar
    Observer

    So the PM and the usual followers heading off to China on Thursday. Included in the party is a public servant who cannot be spoken to…wonder if the Chinese officials can keep some of them in China!!!

  5. Rose Art Avatar
    Rose Art

    @ Just Only Asking

    You are knucklehead and your spellig is terrible.

    Donville is now the worst ever Ministerof Health in Barbados and for that distinction he has had to beat out alot of incompetent people who came before him.

    Donville Inniss in 2011 is calling for scale fees, something the world including Barbados has fought against for the last 25 years because they are against every tenant of fair trade and open market competition.

    The knucklehead believes that if doctors had a set of scale fees it would mean patients would have certainty over what to pay and that somehow would reduce the cost as the fee gougers would be brought in line.

    What knucklehead does not understand or appreciate is that scale fees is a slippery slope, in the final analysis it would become, like the lawyers minimum scale fees and hence anti-fair trade and breach of open market competitiveness.

    Donville needs to read more and talk less.

  6. me Avatar
    me

    @ose Art | June 3, 2011 at 6:55 AM |
    “…Donville is now the worst ever Ministerof Health in Barbados and for that distinction he has had to beat out alot of incompetent people who came before him.”

    it’s patheticthat everything in barbados is about party and if u praise a minister of a particular party, jackasses like you would have to criticize, even when the person is making good points. you called ‘just only asking’ a knucklehead and went on to describe inniss as such also. i read your comments. you are the knucklhead, i think you were in the mirror when you offered your sentiments to ‘just only asking’. i’ve read their comments, they seem to be an extremely articulate individual, expresses more commonsense – without emotion, than you. i guess now i too will fall under your insults. i suggest that when you do respond to me, please do stand infront of the mirror as you did previously.

  7. me Avatar
    me

    @Enuff | June 2, 2011 at 5:22 PM |
    “Someone need to call the Ayshford Bird Park or the Wildlife Reserve for this programmed parrot posting under the nom de plume “Just Only Asking”.

    it is laughable that you could not even respond to ‘just only asking’ when they put all her points out there. points that you knew of and could not even defend. lord have mercy!

  8. Rose Art Avatar
    Rose Art

    @ Me

    I call a spade a spade notwithstanding who it is or what party they are from. Ignorance knows no colour, no creed and certainly no class.

    The DLP has moved away from its socialist values and now taxing to death everyone except the rich and connected in this society.

    When I look at the front benches in Parliament I cringe. We used to have admirable politicians, people who used to inspire us with the thoughts and visions and plans, all of that was well articulated and impressed us as Nation, small are we are.

    I ask you what do we have now? We need more good honest and proven Barbadians to get involved in active politics, for if not, my fear is this country is going to sink and its people are going to starve under the burden of corruption and absence of justice.

  9. Enuff Avatar
    Enuff

    @ Me
    You care to highlight the points? Or are you Just Only Asking’s cage mate?

  10. Just Only Asking Avatar
    Just Only Asking

    @Roseart

    Dont tell people that his/her spelling is atrocious and you cant even spell the word, spelling.
    By the way you have to be “darn” good to write speeches for the international fora, and anyone graduating from UWI in the 80’s with good honours should be able to spell. Further to acquire an MBA with a distinction should mean something.

    By the way, a rose is supposed to be flower much sought after and you are not, art is something that we appreciate and you dont fit into that category.

    Finally if i am a knuckelhead, you are vthe smarted blooger on this site and how about that useless rose and art nobody wants.

    catch ya later miss know all.

  11. Chuckles Avatar
    Chuckles

    @ Cinnamon
    @ Just only asking
    Thanks for giving the BU another version of what took place at the meeting. I am not surprised that the Sanka Price lobby failed.
    Anytime facts are stated, figments of people’s imagination
    will be exposed and dismissed. Alert was first out of the gates with
    his full-page advertisement questioning the absence of certain
    drugs from the Formulary effective April 1st. I suppose he shut
    his mouth up, after the president of the Barbados Pharmaceutical
    Society said at the meeting, that free health care is not possible in
    Barbados.

  12. Enuff Avatar
    Enuff

    @ Just Only Asking

    I contemplated not responding, but I felt obligated to do so simply because you seem clearly to have problems with reading and comprehension. I will do so in two parts to one long singular post.

    You said:
    “My role is not to seek the abolition of any post, bust [sic] to counter arguments like your [sic] et al. I speak from a positon [sic] of knowledge and I have access to any estimates, as well as what benfits [sic] people recive [sic] besides salarie [sic] so dont [sic] think that I pull figures out of my head.”

    My argument was about the inconsistency and incoherence of government policy. You were the one that initiated the issue of ‘wastage’ associated with the establishment of Personal Assistants and Youth Commissioners. I pointed out that they still exist and at what cost sans allowances, benefits etc. The fact that you have no interest in seeking their abolition indicates that in your opinion they are no longer deemed to be wastage or you admit that the wastage continues.

    You further said:
    “The Community Development Division had a scturcture [sic] in place, but the objective of the youth Commissioners and post associated there with was to create posts for party supporters who in some instances did not meet the minimun [sic] academic qualifactions [sic] for entry level post in the service, but were rewarded handsomely [sic] for their political ties.”

    Accusing one party of favouring party supporters and appointing them to posts without qualifications is being disingenuous. The creation of jobs for party supporters, some without the requisite qualifications, is nothing new and continued all across the public service after January 2008: NHC, UDC, RDC, NCC, SSA etc. This practice will remain until there is greater transparency in the recruitment process at statutory boards, which I doubt will ever be realised.

    Another of your statements:
    “…to educate you, the youth commissioners were not trained in survey methods of social investigation, so you cannot claim that they undertake research. You mean that they administered the instrument.”

    I am not claiming anything. If you read my post and understood what I wrote, you would have noticed that I made it clear that those comments regarding what Youth Commissioners did/do were not mine, but were extracted from the government’s DRAFT NATIONAL YOUTH POLICY of March 2011. So clearly you are insinuating that the document is misrepresenting the facts.

    You again:
    “Before you speak get, the document and look at the compostion [sic] of the Council.”

    (1) Each Council shall consist of 15 persons appointed by the Minister by instrument in writing.
    (2) The persons in sub-paragraph (1) MAY be selected from the following categories:
    (a) representative of a community group
    (b) representative of a special interest group or sector of the community
    (c) nominee from EACH of the political parties that are represented in the house
    (d) person in his or her individual capacity
    (e) nominee of the Minister
    (4) The Minister SHALL appoint a Chairman and Deputy Chairman from among the members
    (11) Decisions of each Council are to be by a majority of votes and where the voting is equal the Chairman, in addition to his original vote, has a casting vote.

    The discretionary nature of the Act assigns unbridled power to the Minister with regards to the appointment of Councillors. He/she is therefore under no obligation to appoint persons under 2(a), (b), (d) or (c) for that matter. Small wonder the Councils are constituted and chaired as they are now.

  13. Enuff Avatar
    Enuff

    You continued:
    “How much money was Owen Arthur Personal Assitant [sic] paid? how much money was his wife paid and how did she get the job? and then don’t [sic] forget the Scantlbury [sic] man.”

    Back with the same holier than thou attitude as if this practice does not exist under the current government. Right now there is a Chairman of a Board who is also a Consultant to the parent Ministry. Who was the late PM’s private clerk? Again, the same practice continues.

    You said:
    “Your political [sic] blinkers are preventing you from understaning [sic] the role of the Council, thus i would just say to you that empowerment means arming people with the skills to improve their lot, therefore social, and economic variables must be considered when we speak about empowerment, not to be left out is the political [sic] aspect as well.”

    The above statement supports my characterisation of you as a programmed parrot that lacks reasoning skills. I never denied the importance of the social and economic dimensions to empowerment. There were a number of agencies in Barbados prior to the establishment of Constituency Councils that addressed the issue of social and economic empowerment. In fact, the mission of the Ministry of Social Transformation—an amalgam of the majority of those agencies—was:
    “To contribute to the overall socio-economic development of Barbados and the EMPOWERMENT of all members of society, by fully utilising all available human, financial and technological resources; formulating evidence-based policy; and implementing timely, effective and equitably accessible social programmes and services.”

    What, however, was missing from the framework were mechanisms to facilitate POLITICAL empowerment at the local level. I made it clear that the late PM, in a referenced speech, articulated a vision of the Councils as ALSO, and more importantly, forums for engendering that LOCAL POLITICAL empowerment, which he correctly identified as missing from the governance structure in Barbados. I further argued that the projects you persisted in highlighting did not speak to political empowerment; and that the manner of selecting Councillors and the absence of community participatory mechanisms prevent such from being achieved.

    More diatribe:

    “You got the audacity to lecture to me about wasteage [sic] of funds, what about Kesinton [sic] Oval, the RDC and Urban who spent money on those entities like if money was not a problem. Greenland, the three baths etc. etc., etc. etc..”

    I never attempted to lecture you about wastage because my argument was based consistency and coherency of policy, wastage was your issue.

    However, I am sick and tired of these all same old arguments being used to justify the failures of this government. The truth is that except for Greenland, results from the ‘wastage’ can be seen. Kensington Oval is benefitting Barbados—CLOBI cricket and this year the International Masters Football. I found no information on RDC. With regards to UDC, Minister Sinckler in the Barbados Advocate of 3/19/2009 said that the BLP spent $100m at UDC while in power.

    According to the Auditor General’s Report 2005, after 8 years in existence they had spent over $30 million on building approximately five hundred (500) houses and repairing 800 hundred, and $8.3m to build 90 roads as well as footpaths. In addition, at the end of 2007: 600+ wells were dug; 190+ septic tanks installed; and over 4,000 lots made available for purchase to qualified tenants on tenantries of which nearly 800 households were paid subsidies amounting to just over $8m.

    Since assuming government in 2008, the government has spent over $1b more than it has earned and unlike the ‘wastage’ of the previous government the tangibles are glaringly absent.

    I guess the popular mantra of “Barbados being more than an economy, it is a society” justifies the chasm that exists in our finances; though the dismantling of the BDS in the name of fiscal prudence contradicts the same mantra. See what I mean about inconsistent and incoherent?

    Sir, wastage too is not endemic to the BLP, so painting one party as a paragon of virtue is nonsensical. I am sure the BLP was also guilty of inconsistent and incoherent policy at some point in time, but it just seems a constant feature of this government: Credit Union fiasco, traveling allowances, VAT for hotels, cell phone tax, rum shop licenses, CLICO, free bus fares, and the latest a ‘look again’ at the formulary.

  14. Prodigal Son Avatar
    Prodigal Son

    Well done enuff.

    I am supporting you all the way. Kill he/she with facts and let them do the ad hominem attacks. By the way, has work begun on the St John polyclinic as yet?

  15. Chuckles Avatar
    Chuckles

    @ David
    I thought that the subject of discussion for this blog was ‘Demystifying Government Healthcare Policy’. Didn’t the President of the Barbados Pharmaceutical Society supply the answer by stating that there is nothing such as Free Health Care and Barbadians would have to contribute to their health care in some way? If Barbadians with Internet Service would read the online newspapers from around the world , they would realize that the President is only echoing what the Heads of other Health Services are saying. The policy of every Health Service worldwide is that if you don’t like the medication offered by them, feel free to buy the medication of your choice out of your pocket. The irresponsible journalists and some doctors/pharmacists in Barbados should take time out to read what is going on in other parts of the world , before encouraging the less informed that they are entitled to whatever medication they want free of cost.
    @Bonny Pepper
    I am asking you to use a few expletives to bring this discussion to a closure otherwise we will be ‘spinning top in mud’.

  16. David Avatar
    David

    @Chuckles

    The culture of entitlement has taken root. Does anyone believe Minister Inniss is seeking to transform healthcare in Barbados because it will win him votes? Why not continue business as usual?

  17. Prodigal Son Avatar
    Prodigal Son

    @Bonny Pepper
    I am asking you to use a few expletives to bring this discussion to a closure otherwise we will be ‘spinning top in mud’.

    Is this Bonny’s role on BU???? How much lower will we sink?

    By the way, to those who attended the townhall meeting, did the Minister inform the audience as to what really happened to the eight months supply of Paclitaxel which vanished from the QEH in a matter of days?

  18. Enuff Avatar
    Enuff

    It is political!! To leave things as they are would mean that those areas given greater priority in the quest to stay in power would suffer.

    That is why despite the topic of the thread, other issues have been discussed; because healthcare policy, or any government policy for that matter, should not be devised or analysed in isolation.

  19. Just Only Asking Avatar
    Just Only Asking

    @Chuckles

    I with you, if Minister had any intention of being popular he would not had interfered with health care. I belive that we cant continue like how we used to, to this end we must reform and try to get the best return on investment. Instaed of giving him support for having the the fortitude to introduce these policy inititatives, we have people with myopic thinking from a partisan perspective.

    Go Donvile, I support you nad if you see adjsutments have to be made do them. There are plicical cronies who are always talking about cooruption and wastage, and here is man willing to ensure that we get value for our money and they want to crucify him.

    My girl bonnie when yah ready buse all of them that want to crucify the man you say real sexy.

    Dont mind them that dont have a leg to stand on after the townhall meeting, the real shame. Yah know i is a parrot that cant spell nor analyse so i only regirgertating what ah hear. yah got to forgive amh if a spell any words wrong casue i ant got time to check mah dictionary..

    Bonnie buse the tail that want to destry yah party, you know who a mean.

  20. smooth chocolate Avatar
    smooth chocolate

    @just only asking

    to which ‘Bonnie’ are u referring. urs or the one found here?

    I too was at the meeting. i heard the lady’s sad tale. she said she owed the pharmacist for medication she got previously plus what she was there to get. she said her pension was around $500. she really presented a sad story but i think what she attempted to, did not come to fruition, as it did not make the DLP look bad…what it did was highlighted the plight of the genuinely unfortunate. So i’m glad she told that lie as it only helped to reinforce the need for the minister to look again at the elderly. i thought Mia was brilliant as usual and i hope her idea isn’t thrown out. the Minister should get a standing ovation, he did a marvelous job

  21. Just Only Asking Avatar
    Just Only Asking

    @Enuff

    This parrot has a BA with honours and an MBA with distinction and they were not bought so ponder over that for a while.

    AS the sayiong goes you and your cohorts cant have pins with me or needles. So put that in yah pipe and smoke it. Go come again. i am capbale of writing long useless blogs like you but wont so you have the last laught, you and your tagged team and the Nation failed in your bid to discredit THE HONOURABLE DONVILLE INNISS, so go come again.

  22. Enuff Avatar
    Enuff

    Whoopeeee, a round of applause for ‘Just Only Asking’. He/she is the only one on the blog with an undergraduate and graduate degree. SMDH

    Only a parrot would resort to repeating the same weak riposte as a get out of jail card. What good are degrees if one struggles to demonstrate any gain, intellectually, from one’s academic pursuits?

    For example, the Deputy Speaker of the house also engaged in undergraduate and postgraduate training, yet weekly he pompously declares “the honourable member have five more minutes.”

    Boasting about an undergraduate and masters degree in the 21st century is tres pretentious. Firstly all and sundry now have these credentials, and secondly many of the world’s wealthy, creative and entrepreneurial individuals have neither: Bill Gates, Steve Jobs, Mark Zuckerberg etc .

    If one sees the need to be boastful about their academic accomplishments, one should at least have Ph.D behind their name.

    After writing such drivel, it would have been better for you to keep your degrees to yourself for it is one thing to be a parrot, but an educated parrot is worse.

  23. Just Only Asking Avatar
    Just Only Asking

    @Enuff

    The point is I have them, and sometimes you have to let people like you know that you are not dealing with and uneducated parrot, but one who is capable of spinning the truth, but prefer not to do so.

    The problem with you and your team is that all of you would like to come here and engage in proroganda about the the great DLP, but you and your cronies have a long wait before you see power, so sit back relax and enjoy the wait. Pleas dont ckoke on your vomit.

    Have a wonderful week, Mr. Bright Spark.

  24. Just Only Asking Avatar
    Just Only Asking

    @David

    I have a piece of research on managing change in the orgganisation, so you think that this is something bloggers might be interested in , in light of all the talk about corporate governance

  25. David Avatar
    David

    @Just Only Asking

    Email BU lets have a look.

  26. smooth chocolate Avatar
    smooth chocolate

    @Just Only Asking

    forgive me about the ‘bonny’ thing. i now realized from previous comments that u are not who i suspected u to be. God bless tho

  27. Enuff Avatar
    Enuff

    @ Just Only Asking
    I am not part of any team; I have no cronies and little interest in whether the DLP wins or loses the next election. I do, however, have an opinion and shall continue to use this forum provided by BU to express my views.

    Propaganda? How is referencing the Estimates, the Draft National Youth Policy, the Constituency Councils Bill, Budget speeches and feature addresses by the late PM deemed propaganda?

    You are no longer drowning, you have clearly DROWNED and have been pronounced dead by the Coroner. I await your obituary. Next!!!

  28. Just Only Asking Avatar
    Just Only Asking

    @Enuff

    you have been burried long ago, so you soul needs to be now saved so enjoy your obituary. When you have arisen go continue to push your party’s propoganda, while i use laser guided missiles to destroy your propoganda and cite examples of your ignorance.

  29. just only asking Avatar
    just only asking

    @David

    can you scan the article or have a link established to the articale written by Professor Hanry Fraser in todays’s advocate. Very informative article on the drug formulary.

    People like Enuff and the Scout et at will cringe.

  30. David Avatar
    David

    @Just  only asking

     

    Is this the article you requested? Next time post the link.

    Sensible changes to drug formulary

    6/10/2011

    The continuing controversy about the rationalisation of the Barbados Drug Formulary and the fees to be paid for any prescriptions if filled at private pharmacies calls for some sober and logical comment.

    There are two issues that have been challenged repeatedly in the press and public dialogue, either through a lack of understanding or through vested interests of one kind or another.

    The first is the matter of the reduction of drug choices. In matters of fashion and clothes, choice of motor cars or choice of food, people enjoy a vast variety of choice and spend their money as they choose. When government is attempting to provide comprehensive health care, however, unlimited choice is unaffordable, unnecessary and unreasonable. In the case of the Barbados Drug Service and National Drug Formulary it has driven drug expenditure by government to huge sums, which are unnecessary and wasteful.

    Most doctors prescribe from a limited number of drugs or medicines; studies we did some years ago showed that our primary care doctors prescribed from a range of far less than 100 drugs. Yet our National Drug Formulary had grown dramatically to provide some 700 choices! These include some 25 pain killers and anti-inflammatory drugs, and more than 50 drugs for hypertension. These include several examples of 5 – 7 drugs in the same category, with little difference between them – so few differences that few doctors know these subtle differences, and usually choose a familiar one in each category. To have seven drugs in one category to choose from makes no sense at all; it drives costs up, and increases problems of stocking so many items. While the formulary is dynamic and changes must be kept under review, and ongoing changes (both additions and deletions) made, the principle of reducing these many “ME TOO” drugs is extremely sound and the Formulary Committee and Ministry are to be commended.

    The second matter, of the “Dispensing Fee”, is also perfectly reasonable. Patients who can afford a private physician consultation should have no serious problem with a token dispensing fee! Those who really think they do, have the option of having their prescription filled at a polyclinic pharmacy. The time taken, in the light of current health challenges for many in need, is another consideration. One might take along a good book for any extra wait. This practice, as in the UK, was recommended when our Drug Service was inaugurated. It encourages appreciation of the true cost of drugs and discourages “doctor shopping”, duplication of prescription and wastage of costly “free drugs”; but the advice given to the BDS and Ministry of Health in 1980 was not followed. Instead, a drug levy, 1 per cent of income, I believe, was introduced for a few years. The vociferous objectors now appear to be unaware that Barbados has economic problems. Further unnecessary confusion also exists because of the varying scale of dispensing fee, according to the cost of the specific medication – as opposed to a set fee per item, which is sending mixed signals, and the facts should be more clearly stated.

    In the final analysis, we have been wasting a fortune in unnecessarily costly drugs in Barbados. The rationalising of our Formulary and drug supply practices along the lines of the World Health Organisation recommendations is both sound, sensible and necessary, if our predominantly “free health system and drug service” are to remain.

    Henry S. Fraser
    Emeritus Professor of Medicine and Clinical Pharmacology, UWI

  31. just only asking Avatar
    just only asking

    @David

    Thank you, will do as instructed next time as i am very obedient.

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