est. 2007

Barbados Underground

Bringing News and Opinions to the People

Demystifying Government’s Healthcare Policy

Submitted by Trained Economist . 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…

, , , , , , , ,
Submitted by Trained Economist

.

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. Hants Avatar
    Hants

    Hard cold facts.

    Barbados is not Kuwait or Bahrain.

    I live in Canada. I spend about $270 per month for Advair,Ventolin and Crestor. About $40 is for Dispensing fees.

    It is unrealistic for the Bajans to continue to get free Health care and free drugs.

  2. OLD SCHOOL Avatar
    OLD SCHOOL

    Can yu shed some light on the dispensing fee? What is it for?

  3. OLD SCHOOL Avatar
    OLD SCHOOL

    I am still hoping thsat the way forward is for some enterprising pharmacist(s) to post an ad waving the fee and pick up some business.

  4. Prodigal Son Avatar
    Prodigal Son

    Just Asking,

    I am just saying what was reported in the press and out of the mouth of people on the call in programs. There were pictures of lots of people sitting waiting and reporting that it took them 4-5 hours waiting both at the QEH and Warrens polyclinic. What political spin what? I am a Barbadian and I want what is best for Barbados.

    The whole thing was not properly thought out and this is why it has affected people so badly. As soon as anyone have to offer an opinion on this government you dems get offended. Dont you remember how you all lambasted the BLP government for 14 years, morning, noon and night?

    A retired MOH permanent secretary told me that had he been still at the MOH, there is no way Donville Inniss could bring this before him to be implemented. The cuts would have to be made elsewhere!

  5. Chuckles Avatar
    Chuckles

    @Just only asking
    Agree with you that the days of not questioning doctors are over.
    @David
    I read some comments from Alert in a full-page advertisement couple months ago and he seems to have problems with the Health Care Reform. Whichever drug is removed from the Formulary, somebody will complain that the replacement isn’t working like the original. It is time people like Alert level with the patients and let them know that in some cases they are getting the same medication but instead of a single combination drug, they are now taking two or three tablets. There is a lot of misinformation being fed to patients and by no lesser a persons than doctors and pharmacists who are unwilling to get on board for reasons best known to them. Google ‘The rising cost of prescription drugs and no more free dinners’ and you would see the similarity between the behaviour of some local doctors/pharmacists and their counterparts overseas.

  6. Just Only Asking Avatar
    Just Only Asking

    @Prodical Son

    Clearly the retired public servant misled you, or is this another of you exagerated stories?

    Did the reporter verify that people were waiting for four -to five hours, the devil cite scripture for its own purpose. By the way the system was wll thought out, people like you need to give it little time, but it is in your interest to criticize it for cheap political
    points.

    You have been eduacted that there is no difference between generic and patented, what have you to say on this issue now.

    You need to be armed with emperical information before you write.

  7. Prodigal Son Avatar
    Prodigal Son

    And you do???????

  8. Just Only Asking Avatar
    Just Only Asking

    @Old School

    The mark up for drugs in the special benefit scheme is fixed, so i suspect that the handling fees allow for additional mark up(profit) for the pharmacist.

  9. Just Only Asking Avatar
    Just Only Asking

    @prodical

    Dont comapre me with you, U have eduacted you on the fact that generic is formally patend drugs, how doctors are influence in prescribing particual brands. I know at what I speak.

    Hope u accept my invitation to be present wednesday to relate your exagerated stories, but then you wont have the gumption to come and talk your rubbish.

    we are looking to move healhtcare forward and provide access for all at optimun cost. if you aboard join the train.

  10. David Avatar
    David

    If only we can find a way to transfer the passion of the argument to how do we make the lifestyle change to reduce the dependence on drugs.

  11. Just Only Asking Avatar
    Just Only Asking

    @David

    Yes I agree with you, some of us need to get involved in lifestyle change so that we would not have to be dependent on drugs, hope an artilce can be produced on the blog along that line.

  12. Prodigal Son Avatar
    Prodigal Son

    Just Asking,

    This is the last time I will engage you. You are “a know it all” and this is why our beloved country is in such a mess. Only your opinions matter or are intelligent.

    Thanks for the invite but I do not go into those areas at night. I voice my opinions because I care about Barbados irrespective of who is the government. Thanks be to God for the good health He has given me and I have health insurance and I can pay if I get sick and need medication. My concern is for those who cannot afford to pay for their much needed medication.

    Yes I understand that generic drugs are good and why they are called generic. Thanks if you think you are educating me, we can learn from each other a little everyday.

    Barbados belongs to all of us not only to you Dems.

  13. Pearl Avatar
    Pearl

    I think part of the reason there is so much confusion about this scheme is because of the advert that was put on national TV, which included age groups I believe under 16 and over 65. I know it was not just me that was of the understanding that children under the age of 16 and adults over the age of 65 did not need to pay the dispensing fee. When I had called the Drug service hot line (due to a discussion) I was told that the advert was misleading and they were to produce a clearer one and that everyone who used a private pharmacy who were given the pink slip from the doctor had to pay.

    In my humble opinion they had it right first time in that those under the age of 16 are given free education (I know we pay taxes for it) and those over 65 should not pay the dispensing fee. If this is imposed I would have less of a problem with the dispensing fee.

    If working people are really waiting 2-4 hours for medication, no doubt there will soon be issues in the work place. If it’s a one off not so bad but if it’s a monthly occurrence the employer will be looking at all those hours that you are not being productive (i.e. not at work). Not a good scenario.

    My other concern is yes I understand persons are flocking to the polyclinics but I wonder if there are more people now not going to the Doctor because of all the costs involved? Worse case scenario is that when they do finally go to the Doctor it will be too late.

  14. Enuff Avatar
    Enuff

    The issue is not about bipartisanship (whatever that is in our context) BUT more so about nonsense vs sense. Bloggers argue that cutting costs is necessary to avoid “fiscal ruin”, but the last time I checked:
    $12m (BDS savings) + -$30m (Constit Councils) = -$18m!!
    Proof again of this government’s inconsistent, incoherent and ill-thought out policies.

  15. Chuckles Avatar
    Chuckles

    Hi Pearl

    The newspapers will find all the wrong reasons for not supporting the overhaul at the Drug Service. They depend on sponsorship for their existence.
    I would like you to use the Internet and check every country which has a National Health Service and you would observe that they are all restructuring the service due, in part or totally, to the rising cost of prescription drugs. The hard truth is that Barbados cannot afford to purchase every
    drug that is available on the market to treat every ailment. The mighty America cannot do it either. I would also like the Afro Bajans
    to take a leaf out of the book of Bajans of Asian descent. They not only collect their medication from the Polyclinic but they fully utilize the services offered by the Polyclinics. On morning when I am leaving Brown’s Beach, I see them lining up at the Polyclinic on Jemmott’s Lane for what appears to be their pre-natal checks without making any fuss.

  16. Christopher Halsall Avatar
    Christopher Halsall

    @Pearl: “If working people are really waiting 2-4 hours for medication, no doubt there will soon be issues in the work place.

    Indeed.

    Hopefully immediately at the Polyclinics — just why would it take so long to full-fill a prescription at a Government funded pharmacy which only takes a few minutes at a private sector pharmacy?

    Was Minister Sinckler not featured in this Sunday’s Nation News talking about how greater efficiency could be achieved by way of the private sector?

  17. David Avatar
    David

    @Chuckles

    You are correct the challenge of making national healthcare cost efficient is a challenge for many countries made more acute by the depressed economic conditions.

    An interesting point you touch on is the use of our polyclinics. Many Barbadians don’t want to be seen near them. Could this be part of the problem helping to raise the clamour?

    Who minister would seek to make a change in a health service given the potential fall out?

  18. David Avatar
    David

    @Chris

    Why do you make a simple thing so difficult sometimes?

    You have 5 people waiting prescriptions to be filled averaging say 4-5 minutes. Wouldn’t person 5 have a wait time of say 20-25 minutes?

    You have 30 people waiting prescriptions to be filled using the same variables as above would the wait time for person 30 be 2hrs+

    The MoH obviously got the capacity planning in the polyclinics wrong and it is why a decision was obviously made to recruit additional pharmacists.

    With changes will come issues which have to be addressed quickly. What is obviously is that the current minister is not afraid to make the hard decisions.

  19. Christopher Halsall Avatar
    Christopher Halsall

    @David: “You have 5 people waiting prescriptions to be filled averaging say 4-5 minutes. Wouldn’t person 5 have a wait time of say 20-25 minutes?

    You are assuming a serial system; as in, job 2 can’t be started until job 1 is finished.

    Can not the inputs of job 2 be started before the outputs of job 1 are finished?

    And then the question becomes: where is the blockage in the system which prevents parallelism. Why must so many workers work on only one thing at a time so very inefficiently?

    Let me please put this on the table (again): the private sector pharmacies manage parallelism quite well.

    Why can’t the public sector?

  20. David Avatar
    David

    @Chris

    What we know is that the clinics had been working with one pharmacist before the decision to add another.

    Do you think based on private pharmacy experience 4-5 minute wait for a prescription to be filled is unreasonable?

    Forget your last comment for the purpose of this exercise.

  21. Christopher Halsall Avatar
    Christopher Halsall

    @David: “What we know is that the clinics had been working with one pharmacist before the decision to add another.

    Do we know if another pharmacist (or even an assistant) has been provided since April 1st?

    @David: “Do you think based on private pharmacy experience 4-5 minute wait for a prescription to be filled is unreasonable?

    No.

    But I do resonate with @Pearl’s comment…

    If working people choose to save a (very) few dollars by spending hours going to the Polyclinic Pharmacies, there will be net downside to the economy.

    Just how much is a net producers’ time worth?

  22. David Avatar
    David

    Not sure if the complement of new pharmacist have been rolled out.

    As is the case with any new system/project one must allow for a ‘gelling’ period where evaluation takes place and adjustments made to relieve bottlenecks/congestion etc.

    If after a predetermined period problems continue then major structural work/overhaul becomes necessary.

  23. Christopher Halsall Avatar
    Christopher Halsall

    @David: “If after a predetermined period problems continue then major structural work/overhaul becomes necessary.

    With all due respect, this is a bit like a star-ship captain saying “OK, we’re going to try everyone living at vacuum for a while, and let us see how it works…

    Those who don’t like it, scream out….

  24. David Avatar
    David

    @Chris

    That is bs and you know it. No major change can be undertaken without factoring post-implementation activity and requisite enlistments.

  25. Enuff Avatar
    Enuff

    At the end of the the MoH will be still in Parliament asking for a supplementary.

  26. Christopher Halsall Avatar
    Christopher Halsall

    @David: “That is bs and you know it.

    Please don’t tell me what I know.

    @David: “No major change can be undertaken without factoring post-implementation activity and requisite enlistments.

    So, then, it should be easy to answer the simple question about if the pharmacists at the Polyclinics received assistance on or before April 1st, 2011.

    Nor should it be difficult to answer why prescriptions take hours to fill at the Polyclinics (regardless of assistance at the GoB pharmacies).

    Simple questions, sir.

    Simple questions….

  27. Christopher Halsall Avatar
    Christopher Halsall

    @BU.David…

    Just wondering…

    You are in control of the most important Blog in the Bajan Blogosphere…

    And yet you won’t answer direct questions.

    Why???

    Please answer.

    Why??????

  28. David Avatar
    David

    @Chris

    Your questions are better answered by people in the health ministry.

  29. Christopher Halsall Avatar
    Christopher Halsall

    @David: “Your questions are better answered by people in the health ministry.

    Please David. Don’t be a little coward.

    Tell us what you know….

  30. Chuckles Avatar
    Chuckles

    @David
    You are wasting your time trying to convince some Bajans that they should use the Polyclinic for the services they offer. My wife has been using private pharmacy for the past 10 years to fill her prescriptions. There are times she calls -in her request for a refill overnight and when she arrives at 10 o’clock the following morning , the medication isn’t ready for her to collect. That same company seems to be on a collision course with the Government. My wife
    phoned them a week before 1st of April to find out if her medication was still on the Drug Formulary. The pharmacist who answered told her that they didn’t get the list of drugs from the Drug Service which contained the names of the drugs available. I was shocked because my neighbour’s son who is a drug rep., had the list and when I checked I discovered that the medication was still on the Formularly. Are you telling me that these pharmacies care about the ‘ poor suffering Bajans’ , a term I borrowed from the Nation Newspaper? Bajans, I implore you, if you have an Internet Service, read the overseas newspapers. Some doctors and pharmacists in every country are up in arms against the Health Care Reforms because they and their families no longer are getting their overseas trips and accommodation paid for by the drug houses. The information is there for everyone to see.
    Think for yourselves.

  31. David Avatar
    David

    @Chuckles

    In fact some doctors in Barbados have been known to sell samples.

  32. Chuckles Avatar
    Chuckles

    @David
    You bring tears to my eyes with laughter. Can’t believe yuh.
    The youngsters would say’ Awright den”

  33. David Avatar
    David

    @Chuckles

    Not to stray off topic but how much money do you think a doctor makes from a vaccine batch?

    Let BU help you in the interest of time. The doctor we are told pays about 25-30 dollars for the batch.

    He then charges about 120-180 for a vaccine shot.

    Is it necessary to state how many shots a doctor can get from a vaccine batch?

    Another reason why Bajans should frequent the polyclinics with their poor great selves.

  34. bk Avatar
    bk

    I think we as Bajans are too hand-to-mouth, some of us too lazy, and are always expecting handouts from Government. Could you believe that some people would sit down day after day, consume load after load of high fat, high sugar,high salt, and high cholesterol foods. Later down the road, they get a chronic disease (diabetes, hypertension). Then they become a burden on the health system, because many of them don’t change their habits.
    Stop depending on the Government for every damn thing. Persons living in low lying areas know that their area floods,but how many of these people would look to get members of the community together and do a cleanup before the rainy season comes? Oh no, they gonna wait on Drainage Unit. At midnight, when your house flooding, where do u think the drainage workers are? In their beds sleeping.

    Barbadians, in particular the older ones have for a long time been using herbal remedies. Herbal medicine is a big business on the world level. I too love to read Annette Maynards column in the Nation, about silent doctors, and try some of the things she recommends.

    Stop looking at the Bees, and Dees.

  35. Just Only Asking Avatar
    Just Only Asking

    @Enuff

    I was going to allow you to continue make a fool of your self by not being able to multiply. Each constituency counicl receives $100 000 for the Financial Year. If there are 30 constituency councils, 30×100 000 would equal to $3 00 000 and not thirty million that is fundamental multiplication.

    When you get your facts correct you should come back.

  36. Just Only Asking Avatar
    Just Only Asking

    @Prodical

    You cant engage me in any logical discussion and win, as i have been reading the dishonesty in your writings for a while.

  37. David Avatar
    David

    On the issue of constituency councils have we had all 30 allocated for in a fiscal period yet?

    If the answer is no then the impact on budget is less than 3 million.

  38. Just Only Asking Avatar
    Just Only Asking

    @David

    Those post were requested a little while, but as you know that it takes some time to have post created in the Service. The posts were requested based on an inhouse study done which projected that there would have been an increased in persons using the polyclinics.

  39. Just Only Asking Avatar
    Just Only Asking

    @David

    I guess you get my point, people need to have emperical evidence, the 30 councils were supposed to be all up and running, but i dont know if all are up and running.

  40. David Avatar
    David

    @Just Only Asking

    Those post were requested a little while, but as you know that it takes some time to have post created in the Service. The posts were requested based on an inhouse study done which projected that there would have been an increased in persons using the polyclinics.

    What some have a problem with is the timing of the resources.

    If we were to use a critical path analysis schema then increase traffic at the polyclinics and the recent changes should have been baked into the project for launch.

  41. Just Only Asking Avatar
    Just Only Asking

    @David

    Do you really know the staff complement at the gov Pharmacie?

  42. Just Only Asking Avatar
    Just Only Asking

    #David

    who said they were not baked into the project.

  43. David Avatar
    David

    On the news there was mention of one pharmacist per clinic but that is the point if true.

    Certainly increased traffic should* have been anticipated post April 1?

  44. Just Only Asking Avatar
    Just Only Asking

    will check that and get back to you.

  45. Just Only Asking Avatar
    Just Only Asking

    @David

    The Ministry of the Civil Service reponsible for the creation and estblishment of post. You can request but that ministry must approve. The pont is that they have been finally approved and that should help alleviate the bottleneck.

  46. David Avatar
    David

    @Just Only Asking

    What you seem to be suggesting is that the MoH went ahead with the April 1 move before the posts were blessed by the civil service ministry?

    If the answer is yes then it can be viewed as very risky/reckless decision as the issues unfolding is confirming.

  47. John Public Avatar
    John Public

    Trained Economist

    Let me try to answer a couple of your questions.

    1. The dispensing fee is the pharmacies only mark up, they sell you the drug at their cost and add a dispensing fee to cover all their expenses and any profit. This way of pricing prescriptions is very the norm in many counties all over the world.

    2.In some cases there are generics for brand name products that were previously on the formulary.But I do not get the impression these are what people are complaining about.

    But for just over 200 drugs – there is not any generic equivalent. There are therapeutic class equivalents in many cases , but you need to change to another actve ingredient.
    Unfortunately some people do better on a particular active ingredient than another in the same therapeutic class. These are what people are complaining about.

    And in some cases you need to take two pills to be equivalent to the one pill you were previously taking. So 2 dispensing fees.

    @Chuckles- the distributors always get the list of drugs awarded on tender long before the pharmacies, so medical reps almost always know before the pharmacies what is on the formulary and what is not.

    I suppose you will say why don’t the pharmacies get the list from the distributors. Well unfortunately it is not as simple as that- While a drug may be on the formulary the government sometimes has pharmacy protocols which effect things like quantities that can be supplied or who can benefit or in some cases which Dr’s are allowed to write the drug, or things like certain drugs can not be combined with others etc. So until a pharmacy gets all of this information they cannot really say what is on formulary.

    While a drug might be on the formulary all patients might not be able to benefit from it.

    The list for the pharmacies only became available at the last minute this year.

  48. smooth chocolate Avatar
    smooth chocolate

    @Submitted by Trained Economist
    maybe u weren’t following the reports. the question of how many alternatives, generic or brand name, dispensing fee, residency status were all discussed at 2 conferences in March… and at a public lecture. also in some newspaper articles in feb/march. it would make no sense asking those questions over again. however, there’s a town hall meeting i think tomorrow or wed at St. leonard’s boys where the answer to those questions will be answered again. it’s really surprising that u haven’t seen any of those articles or never attended any to those other public events but the journalists have been putting out that info. maybe u don’t read the news every day?

  49. smooth chocolate Avatar
    smooth chocolate

    @OLD SCHOOL | May 29, 2011 at 2:47 PM |
    it is called dispensing fee not processing fee. the pharmacy could remove it. the patient has a choice of going to the polyclinic or private. all this talk about long wait is over exaggerated, i go the the polyclinic anytime after 2 and spend about 2 hrs

    @Just only asking. i agree with you. it is in the interest of the private pharmacies that this does not work. they were ripping off tax payers from the time they realise there was money in it and loop holes that they could crawl thru. electronic submission help put a cap on that. i read an article on the BDS about 2 years ago which said that in 1995 around 600,000 prescriptions of those drugs for cancer, HIV/AIDS, hypertension, diabetes were filled at a cost of $9 million by 2007 the volume increased to somewhere around 1, 300,000 prescriptions at a cost was somewhere around $32 million. U do the maths.

  50. smooth chocolate Avatar
    smooth chocolate

    @Prodigal Son | May 29, 2011 at 10:19 PM |
    “The problem with all this confusion is that the government started wrong and will end wrong”

    1. u are absolutely correct, which ever party won the elections in 1985 or ’86 (i was too young then to remember) change it so that medication could be free.

    2. u are wrong about old people having to pay for medication. most old people attend the polyclinics.

Older Comments
1 2 3 4
Newer Comments

Leave a Reply to smooth chocolateCancel reply

Trending

Discover more from Barbados Underground

Subscribe now to keep reading and get access to the full archive.

Continue reading