The Healthcare Conundrum
Like many others, I tend to take all the comforts we have achieved since independence for granted. Moreover, we tend to think that what we achieved is free! Unfortunately, this attitude has clouded the judgment of many of us.
During the last few decades we have seen quite a number of Government administered services and businesses churning out negative performances. Some of these ended up bankrupt with the consequential rise in unemployment. There seems to be a distinct fingerprint in all of these, the mark of lack of professionalism, political interference and corruption.
One victim of this crass behaviour is Healthcare. Healthcare has become synonymous with uncontrollable running costs, long waiting lists, construction cost overruns, unmanaged stock, lack of staff, mismanagement of the hospital premises and resources, continuous labour disputes, you name it and you have it.
All of us have experienced some aspects of healthcare and all of us at one point in time came to the stark conclusion, that Healthcare is an extremely complex and expensive service to operate and manage. Going straight to the point, most recent government audits have indicated that healthcare expenditure stands at 8.7% of the country’s gross domestic product. The figure is quite in line with other European countries but slightly behind to the Nordic countries, who usually top the statistics in many other fields. What is fundamental to debate is the economic viability of the service when taking into account the country’s finances and economic outlook. Times have changed since the establishment of the social services, yet the paradigms of operating and managing the service haven’t really changed. So where’s the money coming from? Is the service just being supported through our tax contributions? Fundamentally we are sustaining the service, but a usual it’s hard to make ends meet.
Several times under different administrations, governments have hinted that a radical approach to managing the state sponsored healthcare service had to be devised. Even the general public acknowledges the fact that a change is needed, but it is usually assumed that improvement has to come at no cost! It is also very well known that whoever takes on board the task will be faced by some real tough choices which may make the government of that time unpopular.
Ironically, this political hot potato seems to have reached a turning point, when the current administration has decided to take the bull by the horns by drafting a few bold corrective actions that were not expected. Suddenly we are now experimenting with the possibility bringing on board Private Operators to manage our hospital. I do find this an interesting move and probably an option that should have been considered quite some time ago. Even more fundamental was the due diligence that was carried out, revealing a huge amount of money wasted in the procurement of medicine and other fundamental material and a series of malpractices that were hampering the service.
What is sure is that we have to keep moving in par with the times where the general administration of the public services has to be done professionally and as detached as possible from the political spheres. In this whole scenario, the independence of the private operator is of strategic importance and on the same level, the government has to look into the creation of a regulatory board that takes care of regulating not just the public services but also the private service providers. The role of the regulator has to be that of a guarantor of a reasonable health care service to all the beneficiaries.
Another aspect that we tend to overlook, is the human resource side of the service. Healthcare is primarily made up of professionals. Therefore it is no different than other private service oriented businesses. It is of fundamental importance that the government in charge has a clear vision of the country’s healthcare requirements five to ten years down the line not just in financial terms but also in terms of that human capital needed to keep the service operating at the highest levels. In the past ten years, we have seen the chronic lack of generational replacements due to the fact that lesser quantities of students are attracted to the nursing profession whilst on the other hand we may have abundance of general surgeons! Another aspect that may be seen to be draining the public service is the fact that since the liberalisation of the sector, the private establishments attracted more professionals due to better wages and remuneration packages. Fundamentally, we are not dishing enough nurses and doctors to cater for the needs of the country. We are lucky enough that the European market provides that human capital this is currently lacking.
Going back the costs issue, the overall expenditure need to operate the service will not decline. The tendency is to register increment in costs, partially driven by an ever increase in the ageing population, the increase of the costs of medicine, equipment and equipment maintenance, salaries, etc. Part of the burden will need to be shifted on the beneficiary through a number of measures. One has to look at the establishment of private health care insurances coupled with a healthcare policies that dictate what the state offers and what has to be covered by a private Healthcare insurance. Again, this is a political hot potato and serious discussions have not yet happened. Once more we see the lack of a holistic approach towards solving a problem. The general impasse is driven by the fact that politicians do not legislate exclusively from the national interest’s perspective but there is the inherent instinct of self-preservation. Unpopular decisions don’t get you elected.
I cannot help but not registering continuous lack of professionalism from our leaders. More often leadership ignores the stark reality and there is a tendency of operating in a state of constant denial. Yes, we do have a decent healthcare service but definitely it could be better and it should be sustainable in the first place!
It is also high time that we (the citizens, voters) also acknowledge that we need an attitude of what we take for granted. Nothing comes free of cost, and it is up to us to be diligent before we squander what we have achieved over the decades thanks to the efforts of many.