Introduction and Purpose of Research

This research will be an investigation into the extent to

which free health care or no user fee policy affects the

quality of health care offered at the Kingston Public

Hospital? It will seek to answer the following questions:

Please insert your aims here

The health care system is one of the most important organizations

within a country as it

looks after the health, wellbeing and wellness of its citizens. The care of

citizens is one of the

prime responsibilities of this sector. Health care centres are placed in

different areas to facilitate

giving proper health care to residents. Recently, the health sector has been

plagued with

numerous issues, such as: improper treatment of patients, deplorable

infrastructure, poor

sanitization of facilities and avoidable fatal casualties to patients and

other individuals who use

these facilities due to inadequacies, etc. These issues can all be linked back
to the management of

these facilities, as well as, how the economy is being used, in terms of this

sector.

Approximately, 7 years ago, a no user fee policy was

implemented by the then

Government of Jamaica (Bruce Golding-led Administration), where all fees

were removed from

most, if not, all public health facilities. This policy was quite useful as it

allowed for citizens

from all social class to access affordable health care; not to mention we

were in global

recession. However, it has been argued that the efficiency and quality of

care has deteriorated

tremendously. To each choice, there are advantages and disadvantages; and

this was no

exception as this policy raised multiple issues or concerns like those that

were previously

highlighted.

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 The purpose of this study is to show the true effects that the policy

has on the quality of health care offered in local clinics and also to educate

and sensitize persons on the role the

economy plays on the health sector and the value it places on it.

Personally, I have had a first-

hand view of both the good and bad quality of health care offered; hence,

why in this study I will seek not only highlight the negative but also the

positive aspects. Most of all, this study should educate individuals on

issues facing the economy and give possible solutions. It is my belief that

there needs to be a subsidized fee assigned to health care, where it is

standard and affordable to all individuals. Consequently, this would

provide a balance to the economy and aid in sustaining these facilities

along with other source of financing.

Key Terms

Here are a few of the terms that may be used throughout the study:

Quality of Health Care - describes whether the delivery

of clinical care, including

inpatient, outpatient, and diagnostic services, is appropriate,

safe, and timely.

Efficiency- Making the best use of available resources; i.e.

getting good value for

resources.

Fee- A charge for a service rendered.

Charge- The amount asked for a service by

a health care provider. Cost- amount the

provider incurs in furnishing the service.

Financing- In health care finance, these are the methods of

gaining, and the sources of, revenue in health services. Modes of

financing may vary.

Health Care Costs- The actual costs of providing services

related to the delivery of health care, including the costs of

procedures, therapies, and medications.

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Health (Care) Policy- Decisions, usually

developed by government policymakers, for

determining present and future objectives

pertaining to the health care system.

Health Care Reform- Innovation and

improvement of the health care system by

reappraisal, amendment of services, and removal

of faults and abuses in providing and distributing

health services to patients.

Health Care Sector- Economic sector

concerned with the provision, distribution, and

consumption of health care services and related

products.

Quality- Quality healthcare is how well a

healthcare provider keeps its members healthy

or treats them when they are sick.

Free or no-user fee- without cost or payment.

Care- the provision of what is necessary for

the health, welfare, maintenance, and

protection of someone or something.

Health- the state of being free from illness or

injury and a person's mental or physical

condition.

Quality- the standard of something as measured

against other things of a similar kind; the degree of

excellence of something.

Economy- careful management of available resources.

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 Literature Review

In previous years, several investigations have been

carried out on the effects of the free health care policy, not

only in Jamaica but throughout the Caribbean region and all

over the

world. Those investigations have led to mixed response but at

some point intersected at a

particular view, even though there may be different

resolutions. Some have called for this policy to be abolished

while some are just requesting that it only needs further

development and

management of finances allocated to this sector. However, as

we go further into this research and delve more and more into

this policy, this paper will seek to inform the reader of the

various

views person may have on this, including those highlighted

earlier. This has been an issue over many years, so the

limiting factor is that the various source of publications

required may not be easily accessible even though this is

usually an area of concern.

There has been a boost of support since the 1980s,

for the introduction of user-fees in

public health facilities in developing countries, including

Jamaica. This has resulted in

institutions, such as the IMF and the World Bank, calling for

pro-market reforms. This user fee

has caused many injustices among citizens, which have

reportedly caused them to be turned

away from public health facilities simply because they could

not afford it. This gave rise to the

implementation of the No-User fee policy in 2008, which is

the epicentre of this study. The

Bruce Golding led administration sought to find a way to

bring some form of social justice to

this issue which was a form of classism; due to the mere fact

that those of the lower classes could

not afford it.

In May 2013, a study done by CaPRI (Caribbean

Policy Research Institute) on the matter

of the No User Fee Policy in Public Hospitals in Jamaica

was published. The study basically

4|Page
did an overview of the whole situation since its

implementation, as it sought to identify which

policy would be better for the people fee or free? On

April 1, 2008 the Government of

Jamaica reversed its policy by removing user fees for

services at public hospitals, heralding a

commitment to universal access to healthcare. The national

debate as to whether the public purse

can sustain a quality healthcare service for the benefit of the

most vulnerable social groups has

only been met with anecdotal evidence. This study compiled

the results of a nationwide survey

of public hospitals which investigated the effect of the no-

user fee policy on health services in

Jamaica. It revealed that the abolition of user fees has

resulted in loss of financial resources for

the sector, negatively affecting pharmaceutical and medical

supply stocks, staffing, waiting

times, space, service delivery and processing time. It further

suggested that if the policy is to be

maintained, it must be accompanied by reforms that will

substitute for the loss of financial

resources.

Although this health reform, has its positive

implications it have also left some bad taste

in the mouth of citizens even years after its implementation.

This has led to the Dr Winston

Dawes and the custos of Clarendon William 'Billy' Shagoury

crying foul that this policy has to

go through an article published January 4, 2016 in the

Gleaner dubbed No User Fee Must Go!

Clarendon Leaders Want Drastic Changes For 2016 in

relation to the negative impacts the

people of May Pen have been enduring. Previously, in an

article dated February 2015 published

by Dr Chris Tufton entitled Time to Review the No-User-

Fee Policy? similar sentiments were

expressed in relation to health facilities in May Pen. This

article came after volumes of concern

and protests from both patients and doctors at the May Pen

Hospital that past week as yet another

example of a Jamaican health sector in crisis. It spoke of the

claims by patients of very long

5|Page
waiting hours to see a doctor and a shortage of beds and

medical supplies and more of the effects this policy has on

the Health Sector.

Despite most of the sources speaking of its effect on

Jamaican Nationals; lets not forget

those in the Diaspora. It was pretty intriguing when this

journal entry popped up illustrating the

concerns that they (citizens in the Diaspora) have on this

policy; as well as, they expressed the

possible repercussions that they may face as a result of it, if

they return lets say after retirement.

Vol. 61, No. 2 entered into the West Indian Medical Journal

in March 2012 was entitled

Healthcare in Jamaica mainly gave concerns that the

returnee residents have with this no user

fee policy. It was a bearer of good and bad news as they

thought it was good that health care in

Jamaica was free to all citizens and legal residents at

government hospitals and clinics but it took

an about turn as it began to lament on the services and

conditions available due to this freeness.

This is evident where the writer expresses that, its not all

good, one of the drawbacks to free

health care is the very long lines and poor

service, with a no appointment booking

system

accepted by the physicians. It then gave an

illustration from a secondary source (local

newspaper) where stories have been told of person going to

the hospital very early and leaving

very late with little or no medical assistance. Another

illustration, which seemed to be a personal

experience, was that the writer now finds it rarely uncommon

for scores of persons to be seen

gathered at hospital pharmacies hours prior to its opening

and then when open just to hear that

they are lacking in supply in the medication you want. Many

would love to access the private

doctors and clinic which are widely available but they dont

have funds or insurance to cover the

cost.

Similarly to the cries in Jamaica, There seems to be

no end to the stories of the national

public health system inn Trinidad failing to deliver quality

healthcare to patients who go there

6|Page
for services. This was revealed in an editorial published by The Guardian
Newspaper in

September 2011. It highlighted the most recent incident

which involved the death of a 33-year-

old woman at the San Fernando General Hospital. She

reportedly died after undergoing a C-

section at the southern hospital. Even though it was too early

to say definitively whether or not the hospitals care system

was deficient, which may have resulted in the death of the

woman. Nevertheless many had the notion due previous

performances by the facility which may have not been up to

the international accepted standard. They even conspired that

the incident could have been avoided if the system had

performed up to standard. The editor continued to voice the

concerns of the citizens and patients arising from this

incident.

In contrast to Jamaica, Barbados has long been

known as one of the healthiest places in

the world and its healthcare reflects this. According to

(Healthcare in the Caribbean, 2016) they

have a very high standard of healthcare and it is accessible to

all citizens. Their main hospital,

the Queen Elizabeth Hospital, has the capacity to

accommodate over 600 patients and also offers

a variety of specialized treatments. Similarly, however, the

citizens of Barbados are entitled to

free health care same as Jamaicans but as a result of the

agreement they have with UK.

Additionally, they have subsidized prescription fees for children and the
elderly; hence

everybody else that fall outside of those age groups would

have to pay. In the same breath not only has it affected

Jamaica and its Diaspora, or the Caribbean region but

places such as United States of America and Armenia.1

To conclude this review, based on the researches that were

conducted, it revealed that

such a move requires a strategic approach. Researches

purported that the removal of user fees in

the public health system generally had positive effects on

access. However, there is the need for

policymakers to mobilise resources to meet the anticipated

increases in demand. This may call

1
Articles and sources that have been reviewed or mentioned can be found it the
appendices.

7|Page
for leaders to hold consultation with key stakeholders, and

monitor and evaluate change. If more thought is placed into

it and it is revamped effectively then we may be able to see

the true results of this policy should be positive.

I cannot tell if this literature review makes sense since you have not
outline any aims.
8|Page
 Data Collection
Sources

To be able to conduct this research, the researcher

utilized both primary and secondary

sources to collect data. The researcher, however, decided to

take a more primary, quantitative

approach in investigating how the no user fee policy

implemented affects the quality of health

care offered in the Kingston 4 area and to what extent. So,

information was gathered by the using

questionnaires and was backed up with that of a few credible

secondary sources. Hence, the

primary source used was a questionnaire and the secondary

sources were information cited from

relevant books, news reports and newspaper articles on this

particular topic.

Firstly, questionnaire is a data collection method that

is used to collect data by issuing a list of questions with

targeted or closed-ended responses. The main reasons for

 selecting this method of data collection, is that it can be used

in numerous ways, such as:

It gives a more standardized response.

It yields more genuine responses due to guaranteed

anonymity.

It has the ability to collect a large number of data in a short

period of time.

For easy comparative analysis purposes.

Moreover, it is less time consuming than any other method. The

questionnaire consisted of only

20 questions in which 19 of them were closed-ended making

it easier to quantify and only 1 was open-ended giving the

respondents a chance express their view on the topic.

Approximately 20 questionnaires were successfully

completed out of the 25 intended; they were distributed by

the researcher to both workers and patients at the KPH

health facility.

Lastly, the secondary sources may not have been used as the major
data collection

method but it played a very integral role in putting it together as they were able to
cover areas of

9|Page
 the research that could not be covered by the questionnaire.

Books are used as a data collection method as it collects

recorded and printed data; it was used by the researcher to

collect data from recognized, credible sources that are

considered to be reliable data. News reports and newspaper

articles are used as a data collection method as it collects

data that are published by recognized news outlet or media.

They were used in this study to collect information that was

published by the most reliable source of news networks in

Jamaica.

For the presentation of data each diagram must be on a separate page. Also
donuts are not accepted.

Also I cannot correct from the data presentation onwards because I dont know
what your aims are.
10 | P a g e
 Presentation of Data

How long have

you been
attending this
health
facility?

5 and over

3 -- 4

1 -- 2

<1

0%
10%
20%
Respon 30%
dents 40%
(%)

Figure 1: Bar graph showing how long the respondents have been
attending the

Kingston Public

Hospital health facility

 How would you describe the wait time before seeing
a doctor?

Time Period Number of Respondents

(%)
< 1 hour 20
Time (years)

2 - 3 hours 50

4 - 5 hours 20

> 5 hours 10

Table 1: Table showing the respondents wait time before

seeing a doctor

11 | P a g e
 How would you rate the condition of
the facility
and
medical equipments
used?

Very Good
Poor
10%
10%

Good
15%

A
v
e
r
a
g
e

6
5
%

Figure 2: Pie Chart showing how the respondents rate the

condition of the facility at KPH and

 medical equipments

used

Have you ever used a private

health care service?

Yes
40%

No
60%

if the respondents have ever used a private health care

Figure 3: Pie service
Chart showing

12 | P a g e
On a scale of 1 to 5, with 1 being
extremely poor and 5 being excellent,
how would you rate the health services
offered since the implementation of the
no
user fee policy compared
to previous times?
Condition Number of Respondents

1) Excellent 2

2) Very Good 2

3) Average 5

4) Poor 7

5) Extremely Poor 4

Table 2: Table showing how the respondents rated

the health services offered since the

implementation of the no

user fee policy

How would you rate the

quality of the service
offered at the Kingston
Public Hospital versus
that offered at private
 70 medical facilities?
60
50
40
30
20
10
0
Very
Good Good Average Poor
Quality of
10 30 40 20
health care
and
service 40 30 25 5
offered at
KPH
Quality of
health care
and
service
offered at
Private
Health
Clinics

Figure 4: Stacked Column graph showing how the

% of Respondents

respondents rated the quality of care and

services offered at private medical facilities

versus that offered at KPH

13 | P a g e
 Which measure
would be best
suited to cater for
citizens and to
reduce the strain of
the economy?

60

0
Re-implement Offer free health Subsidize
user fees care to only the medication
or
elderly and doctor vist
Responses children

Figure 5: Column graph showing the measure chosen by the

respondents that

would be best

suited to cater for citizens and reduce the strain of the

economy
 Since the government
has implemented a free
% of Respondents
health care policy; do you
believe that this system
affects the quality of
health care
offered at health
institutions?

No
30%

Y
e
s

7
0
%

Figure 6: Pie Chart showing respondents view on if implementation

of the free health care

policy affects the quality of health care offered at health

institutions

14 | P a g e
 Which would you prefer to go, to
seek medical
assistance?
None

Health Clinic

General Hospital

Family Doctor

0% 10% 20% 30%

40% 50%

% of Respondents

Figure 7: Bar Graph showing the respondents preferred place to go to

seek medical assistance

Do you think the no user fee policy

should be
abolished?

40%
Y
es
 N
o 1st Qtr

60%

Figure 8: Doughnut showing the percentage of respondents and their

choice on

whether the no

user fee policy should be abolished or not

15 | P a g e
 Which would you prefer to seek medical assistance?

Fa mi l y Doctor

General Hos pi tal

Heal th Cl i ni c

None

0% 5% 10% 15% Col umn2

20% 25% 30% 35% 40% 45%

Figure 7: Bar Graph showing the respondents preferred place to go to

seek medical assistance
 Sales

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Heal th Cl i ni c

None

0% 5% 10% 15% 20%

Col umn2
 Analysis of Data

Figure 1, drafted from question 5, illustrated the

period of time the respondents have been utilising the

Kingston Public Hospital (KPH) health facility. The results

showed that 40% of the respondents said that they have been

attending the facility for 3 to 4 years, 35% saying 5 years and

over and the remaining 35% was either attending the facility

for less than a year or for 1 to 2 years (10% and 15%

respectively).

Table 1 was in response to question 10; it showed the period of

time in which the

respondents had to wait before seeing a doctor at KPH. The study revealed
that 50% of the

respondents had to wait for 2 to 3 hours, 10% for over 5

hours, 20% waited for less than an hour and correspondingly

4 to 5 hours.

Figure 2 which came from question 6, showed how

the respondents rated the condition of the facility at KPH

and the medical equipments used. The results showed that

65% of the

respondents rated the conditions of the facility and the

medical equipments used being average, 15% rated it good,

10% rated both poor and correspondingly very good.

Figure 3 was in response to question 11; it showed

whether or not the respondents have ever used a private

health care service. The results showed that only 40% of

the respondents have ever used private health care while

the remaining 60% have not.

Table 2 drafted from question 20, showed how the

respondents rated the health services offered since the

implementation of the no user fee policy. The results

highlighted that out of a total of 20 respondents, 2 rated it

excellent and correspondingly very good, 5 rated it average,

7 rated it poor and 4 persons rated it extremely poor.

16 | P a g e
 Figure 4 drafted from questions 7 and 12, illustrated how the
respondents rated the

quality of care and services offered at private medical

facilities when compared to that offered at

the Kingston Public Hospital. The line graph depicted that

40% rated the private health care

services to be very good, 30% rated it good, 25% average

and the remaining 5% poor. Whereas,

the health care services at KPH was found to be average by

40% of the respondents, 30%

considered it to be good, 20% poor and 10% very good.

Based on these responses, the trend that

can be seen indicates that the majority of the respondents

have a higher or more positive rating

for the quality of care and services offered at private health

facilities. The trend is that as the

rating for the private health facilities decreases (from very

good to poor); that for the KPH

increases up to average.

Figure 5 was in response to question 17; it showed which measure

the respondents
considered as the best suited to cater for citizens and reduce

the strain of the economy. The graph revealed that 50% of the

respondents would prefer if the no-user fee was offered to

only the

children and the elderly, 40% would rather if medications or

doctor visits were subsidized and the remaining 10% would

want for the user fees to be re-implemented.

Figure 6 which came from question 15, showed the

respondents view on whether or not the implementation of

the free health care policy affected the quality of health care

offered at health institutions. The results depicted that 70% of

the respondents indicated that yes the policy has affected the

quality of care offered while 30% said no.

Figure 7 which came from question 13, showed

where the respondents preferred to seek medical assistance.

When asked the preferred place to go seek medical

assistance, 40% of the respondents said their family doctor,

30% said the general hospital, 20% would rather go to the

health clinic and 10% would not go to any and just stay

home and use home remedy.

17 | P a g e
 Figure 8 drafted from question 16, speaks to

whether or not the respondents believe the no user fee

policy should be abolished. While 60% of the respondents

were in agreement to the abolition of the policy, 40% was

in opposition.
18 | P a g e
 Discussion of Findings

Through this research, it was discovered that

majority of the respondents considered the

quality of care and services offered at the Kingston Public

Hospital (KPH) to be average, as well

as the facilities and the medical equipments used in the

various procedures. This is somewhat

commendable that they are receiving health care under

satisfactory circumstances. Meanwhile,

the minority of responses were geared towards both

extremes, that is, very good or poor. This

mere contentment with the infrastructure may be a possible

reason as to why they choose to

continue utilizing public health services rather than private

over the years. However, the findings

yielded by the researcher depicts a complete twist to what

was discussed earlier from the variety

of articles and other illustrious forms of complaints lodged

by citizens right across the island.

They expressed the vast number of discontentment that the

citizens have to endure just to get

proper health care.

Similarly to the sources of literature reviewed earlier, most of the

respondents have

shared comparable sentiments as they expressed how they

have to wait for a long, 2 to 3 hours

before being attended to. When a few of the workers at the

facility were asked about the long

lines (hence, long wait time period), it was made to

understand that this has been the case since

the implementation of the no user fee policy in 2008. Since

then there have been shortage of

workers, medical supplies and equipments as funds

allocated to the sector have been strained

excessively to cover all the expenses of this sector. These

arguments can be supported by the

Health Access Study (CaPRI, 2013), which profoundly

stated that since its implementation, it

has negatively affected the health sector in areas such as

staffing, medical supply stocks and

waiting times due to the loss of financial resources; which

was coincidentally found in this

19 | P a g e
research. It is also supported by the journal (Healthcare in

Jamaica, 2012), in which the Diaspora voiced its concerns

reiterating the agony faced by the returnee residents towards

the long lines. Hence, this argument stands firm.

Subsequently, the data yielded that most of the respondents have

never used private

health services. Notably, more persons considered health

care to be better in the private health

sector rather than public health services. As a result, this

implies that other factors may play a

role in the low usage of the private health services such as

affordability and proximity.

Additionally, a significantly higher number of individuals

thought that public health care was

poor as opposed to that of the private health sector. In spite

of this significance, many would

question why are they enduring these hardships by keep

going to KPH over the years, the simple

fact is that they just cannot afford to pay the fees at the

private health care facilities; hence why

they continue to use it. This is somewhat supported in the

literature review (paragraph 2), where

the IMF and World Bank lobbied for a pro-market reform as

there were in high signs injustice as

patients were turned away because of the same reason them

not being able to afford it. However

in recent times health care have become accessible to all but

if you seek high quality treatment

that would have to be paid for and maybe at cost

unaffordable by the social groups. This act of

classism was what was being avoided but unknowingly ran

right back into it.

Amidst the cry for more facilities to be built to attend

to the constantly growing

population, it was the general view of the respondents that

before the government can consider

building new facilities, it should seek to circumspectly

evaluate the current ones and then further

developments can take place, in order to upgrade them to

their full potentials, if the needs be.

Thereafter, it can be concluded if there really is a need for

new health facilities to be built. Also,

in the same way the view aroused that how can there be any

construction of new infrastructures

20 | P a g e
when there is hardly any funds to support the current ones, along with its
other stipulated

responsibilities. In general, the call is for the government

to take a systematic approach to this policy in going

forward.

In addition to just simply investigating the effect of

the no user fee policy on the quality

of healthcare, alternative measures which could possibly

alleviate some of the issues raised were

also sought. The results highlighted that the majority of the

respondents would prefer a decision

be made in which the no user fee policy is applied to the

vulnerable socials groups (children,

elderly and special needs). This would in turn, ensure that

those who have more of a challenge in

accessing good health care will be able to utilize these

services when necessary. On the same

hand, fewer people stated they would prefer if the medications and
visitation fees were

subsidized. Only a very few of the respondents has expressed

their desires for the user fees to be

re-implemented. Supporting evidence for the alternative

measures suggested, can be seen in the

literature review (paragraph 7) where some of these same

suggestions forms a part of the health

reform system in Barbados, which has a very successful

health sector. So if some of these

measures are implemented in Jamaica as well, the health

sector may begin to thrive and show

more positive results and reflect in the type and quality of

service received.

Correspondingly, the findings also depicted a slightly

significant majority of the

respondents profoundly indicating that they would not want

this policy to be abolished but at the

same time indicating that they are not all pleased with it. This

argument was refuted as

(Cunningham, 2013) and (The Gleaner, 2016) explicitly

called for the policy to be abolished as

in their eyes it is causing more harm than good. So through

all this the economy plays a vital role

in the development of a country and in this case specifically

the health sector. However, outside

of the part the economy has to play in this development,

more thoughtful and strategized

21 | P a g e
planning and by extension proper management has it be instituted for
further growth and

development to occur through this sector as was indicated latently by the

findings.

By the findings, it can be therefore said that the stated purpose of

the research was

achieve as the true effects that the policy has on the quality

of health care offered in the clinics (specifically KPH) was

shown. Also, as a result, it can be implied that persons

were becoming more educated and sensitized as to the role

the economy plays on the health sector, as well, the value it

places on it, through this study.

22 | P a g e
 Conclusion, Limitations and
Recommendations

The researcher has discovered that the patients who attend the
clinic at the KPH have

stated that the quality of health care received at the facilities

is averaged and when compared to

the quality of care offered at private health facilities, which

was stated to be above average.

Furthermore the patients believe that services offered to

them can much be improved through

medical officials adequately allocating time to each patient

to carefully attend to the; as the time

in which services are offered and the wait time are usually

one of the major turnoffs. It can

further be concluded that the free health policy is a major

contributing factor to the many issues

and downfalls currently affecting the sector in terms of the

quality of care and services offered at

facilities.
 Limitations

There are a variety of factors that may have resulted

in the findings being limited. The

sources of literature used to gather data on this area may have

been outdated, as some of the

publications were dated as much at 5 years old. Another is

that the main instrument of data

collection used, that is, the Questionnaire- was also a limiting

factor as it restricted the researcher

to view the issue at a certain scope. The sample size used in

the study was relatively small

preventing the researcher from getting a more generalized

finding; which may have resulted in

the results being limited.

You must discuss at least four
limitations each in a separate
paregraph.

23 | P a g e
 Recommendations

It is recommended that the Ministry of Health

increases its service delivery capacity to

keep up with the high levels of utilisation, which will seek to

lessen lengthy wait periods. This

can possibly be done by implementing a number system or an

appointment system. This method

may alleviate some of the current challenges faced as it

would ensure that things a done on a

timely basis and also will avoid patient being there for

unnecessarily long hours. Also, a further

and more generalized research should be conducted on this

topic; as there may be other factors

affecting the health system that could also be investigated to

arrive at a more detailed conclusion.

Lastly, it is recommended that seeking donations from private

sector to aid in the financing

poorly maintained facilities, as it would beneficially fund the

improvement of these facilities.

You must discuss at least three
recommendations each in a
separate paragraph.

24 | P a g e
The bibliography must not be written in bullets it must be written in alphabetical
order based on the authors surnames. Also please pay attention to the
specifications of the APA style such as the indentation of the second and third
lines of each reference.

Bibliography
CaPRI. (2013, May). CaPRI Caribbean. Retrieved March 2016,
from

http://www.capricaribbean.com/sites/default/files/publ

ic/documents/report/no_user_fee_p

olicy_in_public_hospitals_in_jamaica.pdf

Cunningham, A. (2013). Free Health Fallout -

Too Much Freeness - No-User-Fee Policy

Worsening Poor Service - CaPRI Study. The

Gleaner. Retrieved February 12, 2016

Fernholz, T. (2010). US Healthcare reform:

the economic effect. Retrieved February 12,

2016

(n.d.). Health sector in Armenia and the fee-waiver

program. Armenia. Retrieved

February 12, 2016, from

http://www.who.int/management/effectsoffeewaiverarmenia.pdf

Healthcare in Jamaica. (2012). West Indian Medical Journal.

 Healthcare in the Caribbean. (2016, March).

Retrieved from Caribbean Buying Guide:

http://www.caribbeanbuyingguide.com/content/caribbe

an-healthcare-caribbbean

Hibbert, K. (2015). Doctors blame lack of

resources for poor health care; Ministry to

investigate supply problems at

hospitals. Jamaica Observer.

The Gleaner. (2016, January 5). No User Fee must go!!!!

Clarendon Leaders want

drastic Change 2016. Jamaica Gleaner. Retrieved March

2016, from http://jamaica-

gleaner.com/article/news/20160105/no-user-fee-

must-go-clarendon-leaders-want-drastic-

changes-2016

The Guardian. (2011, September). Healthcare System still

deficient.

25 | P a g e
26 | P a g e
 Questionnaire

Instructions: Please answer the following

questions to the best of your ability by simply

placing a tick () in the box beside your answer

and by writing your answer(s) on the line(s)

provided at the appropriate time Please be

reminded that any information is kept

confidential and your identity is not required.

1. Gender:

Male Female

2. Age Group:

16-30 31-50 51 & over

3. Which social class do you belong?

Upper Class Middle Class Lower Class

4. a) Are you a frequent patient of the Kingston Public Hospital

(KPH)?
 Yes No

b) If yes, how often?

1 - 2 times a week Every 2 weeks

Once a month Very rare

27 | P a g e
5. How long have you been attending this health facility?

Under a year 1-2 years 3-4 years 5

years and over

6. How would you rate the condition of the facility and medical
equipments used?

Very Good Good Average

Poor

7. How would you rate the quality of the service offered at the
Kingston Public Hospital?

Very Good Good Average

Poor

8. How would you rate the administration of medicines at KPH?

Very Good Good Average

Poor

9. How were you treated by the medical officials or the workers at the
facility?

Very Good Good Average

Poor

10. How would you describe the wait time before seeing a doctor?
 Less than an hour 2 - 3 hours 4 - 5 hours
Over 5 hours

11. Have you ever used a private health care service?

Yes No

12. How would you rate the quality of care and services at the private
medical facilities?

Very Good Good Average Poor

28 | P a g e
13. Which would you prefer to go, to seek medical assistance?

Family Doctor Health Clinic General

Hospital

None of the above, stay home and use home remedy

14. What are some of the faults of public health care that would
motivate you to attend

private health clinics?

Long waiting time Limited attention given

Inadequate resources Poor customer service

15. Since the government has implemented a free

health care policy; do you believe that

this system affects the quality of health care

offered at health institutions?

Yes No

16. Do you think the no user fee policy should be abolished?

Yes No
17. Which measure would be best suited to cater for

citizens and to reduce the strain of the

economy?

Re-implement user fees

Offer free health

care to only the

elderly and

children

Subsidize

medication or

doctor visit

29 | P a g e
18. In your opinion, do you think that the

government should build more health

infrastructures and why?

___________________________________________

_____________________________

___________________________________________

_____________________________

___________________________________________

____________________________

19. On a scale of 1 to 4, with 1 being the least and 4

being the most, Rank the following

factors on how they affect the quality of health

care offered at KPH since the

implementation of the no user fee policy

compared?

Lack of technology Lack of Resources

Poor Management Poor trained health

professionals
20. On a scale of 1 to 5, with 1 being extremely poor

and 5 being excellent, how would you

rate the health services offered since the

implementation of the no user fee policy

compared to previous times?

1- Excellent 2- Very Good 3-

Average

4- Poor 5- Extremely Poor

30 | P a g e
 Articles

No User
Fee Policy
in Public
Hospitals
in
Jamaica

D
a
t
e

P
u
b
l
i
s
h
e
d
:
M
a
y

2
0
1
3

D
a
t
e

R
e
t
r
i
e
v
e
d
:

M
a
r
c
h
2
0
1
6

D
o
c
u
m
e
n
t

A
u
t
h
o
r
(
s
)
:

C
a
P
R
I

Document link:
http://www.capricaribbean.com/sites/default/files/public/doc
uments/report/no_user_fee_policy_i
n_public_hospitals_in_jamaica.pdf

_____________________________________________
_____________

West Indian Medical Journal

Print version ISSN 0043-3144

West Indian med. j. vol.61 no.2 Mona Mar. 2012

Healthcare in Jamaica

Quality medical care in Jamaica is one of the

prime concerns of many returnees and residents. The
good news is healthcare in Jamaica is free to all citizens
and legal residents at government hospitals and clinics.
This includes prescription drugs, however, its not all
good, one of the drawbacks to free
health care is the very long lines and poor service, with a
no appointment booking system
accepted by the physicians. There have been stories in the
newspaper of people going to the

31 | P a g e
hospital early in the morning and leaving late in the day not having seen a
doctor - the truth is
this is now very common, even for the very sick, the system
simply cannot cope with the volume or demand.
Prescriptions are not easy to obtain. It is not
uncommon to see 20 - 30 people gathered at
a hospital pharmacy two hours prior to its opening. The
closer to the opening time, the more
people congregate to receive the medicine they need and
probably cant afford. Its not unusual
to hear that patients are turned away because of either a lack
of supply or a drug the pharmacy
doesnt stock. If the person really needs an unavailable drug
they must go to a public drugstore
and pay for it or do without.
Private doctors and clinics are widely available as long as you have
the funds or
insurance to cover the cost, these can be of the very highest
standards but can be very expensive, and even here long
queues can be quite normal. Many leave treatment until they
can be off
island, but this is of course not always possible.
Medical insurance is available from several different companies.
However, health
insurance CANNOT be purchased if you are 65 years or
older unless you have been previously
enrolled before your 65th birthday in a Jamaican plan with
some operators and insurance
companies.
- See more at: http://coming-to-jamaica.com/?
page_id=61#sthash.Okad8xp9.dpuf
_____________________________________________
_____________

Free Health Fallout - Too Much

Freeness - No-User-Fee Policy
Worsening Poor Service - CaPRI
Study

Published: Tuesday | June 11, 2013

Retreived: February 12, 2016

The quality of service in Jamaica's public hospitals has

got worse since the no-user-fee policy was introduced
five years ago. It is now ineffective and inefficient, with
nurses and doctors displaying an apathetic attitude
towards patients and their general duties.

32 | P a g e
So said the findings in a review of the system by the
Caribbean Policy Research Institute
(CaPRI).

Conducting the study between April 15 and May 20

across all 14 parishes, CaPRI said it was also evident that
the service has not only got progressively worse but also
exceedingly slow. Compounding that is the increased
patient-to-health-care worker ratio and insufficient
medication and medical supplies to meet the demand.

"The quality of service would be better and faster if people were paying.
Doctors and nurses
would have a better attitude and the hospitals would operate
more efficiently," noted some of the respondents who were
interviewed.

"The hospitals just cannot afford the luxury of free health

care and the Government can't afford to foot the bill alone.
It only results in an abuse of the system and overwork the
health-care workers. When it is free, doctors and nurses
display a poor attitude."

Seeking to investigate the effect of the no-user-fee policy on

health services in Jamaica and to
explore the scope for returning to a fee-paying system in the
future, the study noted that several
persons were calling for the reintroduction of user fees on
the grounds that free health care was
not sustainable. Both health-care workers and patients were
of the view that 'those who can pay,
should'.

"It needs cash to care and this will help to greatly

improve the system. People should contribute to their
own health care, as it's very costly," those surveyed
stated.

CaPRI has recommended that if the policy is to be

maintained, it must be twinned with a
package of reforms that address longer term health-systems
issues, in particular, adequate
financial resources, health worker availability and
performance and drug supply chain
management.

33 | P a g e
 "It is worth studying the impact that the policy
has had on the overall 'health of the
nation' and whether or not there has been an increase
in preventative health care," CaPRI
concluded.

As part of its commitment to universal access to

health care, in 2008 the Bruce Golding-
led administration removed user fees for services at public
hospitals, except the University
Hospital of the West Indies. This was a significant departure
from a policy of user fee
reintroduced in 1984.

The Government is hosting a series of public

consultations during which members of the
public are allowed to propose ideas to remedy the woes in
the country's health-care system.

The CaPRI study was carried out with the aid of grants
from the International Development
Research Centre in Ottawa, Canada, The Gleaner
Company Limited and the National Health
Fund.

_____________________________________________
____________
 T

Healthcare system still deficient

Published: September 30, 2011

There seems to be no end to the stories of the

national public health system failing
to deliver quality healthcare to patients who go there for
services. The most recent
incident involves the death of a 33-year-old woman at the
San Fernando General Hospital.

34 | P a g e
She reportedly died after undergoing a C-section at the
southern hospital. It is too early to say definitively
whether or not the hospital care system was deficient and
hence the death of the woman. However, because of what
is generally perceived as the almost institutional
unprofessional performance of our public health
institutions, the assumption could be
widespread that the womans death could have been
avoided if the system had performed up to an
internationally accepted standard.
Without seeking to do a detailed review of
questionable deaths over the last ten
years, it is public knowledge they have ranged through
patients, many of them children,
not being promptly or adequately treated, mothers dying
during and after child birth,
failure to accurately diagnose diseases and therefore give
proper treatment, the unsanitary
state of national health institutions, non-functioning
equipment, the absence of basic
equipment expected of a country as wealthy as Trinidad
and Tobago. The comment is
made about the relative wealth of T&T for the purpose of
pointing out that this is not
some backwater country without a capacity to provide its
citizens with a high standard of
basic healthcare. Moreover, a large percentage of
government budgeting over the period
has gone into the health system to provide the physical
facilities, inclusive of buildings
and conditions on the wards of the hospitals and the
medications required.
With regard to medical care, the cost of
government scholarships, the funding of the medical
faculties of the University of the West Indies, the salaries
to medical staff have run into hundreds of millions of
dollars and yet we receive reports of unprofessional
treatment of patients. What is more, this is a country with
a long history of exceptional medical professionals,
doctors, nurses and researchers who have had outstanding

international professional careers. The importance of that

is that young medical
professionals are not starting from scratch; they have a
base, a tradition and examples of
professionalism to follow as they strive for excellence.
One area of healthcare that has
often been called into question is the administration of
the public health institutions. But
here too there has been quite an amount of government
expenditure in producing
management experts and, undoubtedly, there will be
more in the specialist field of
healthcare management.
Perhaps this is an area for renewed discussion
and attention by the Government.
Here the assumption cannot be that because someone
emerges as an excellent doctor or
35 | P a g e
nurse, he or she automatically qualifies to be a health administrator.
One result of the
questions surrounding the quality of public health
services has been the reality of people, who have the
wherewithal, going abroad for basic healthcare which
any country of the stature of T&T should be able to
provide. Fact is that many such people have lost, or
indeed never had, confidence in the system.
Then there is the view that citizens wanting to get
the best of what is on offer at the hospitals and public
health centres must engage in some form of corrupt
activity, such as bribing an official. The relatively new
Minister of Health must challenge himself to bring
resolution to problems of the healthcare system before he
leaves office.

_____________________________________________
___________

Health sector in Armenia and the fee-waiver

program

Dated: February 12, 2016

Link: http://www.who.int/management/effectsoffeewaiverarmenia.pdf

This section describes the evolution of the health sector during the
nineties and the
implications in terms of access to health care, especially
among the poor and other vulnerable
populations. The transition process in Armenia involved the
health sector in at least two
dimensions. First, the overall decrease in public expenditures
in health care during the early
nineties affected the number of personnel, quality of services
and the maintenance of the existing infrastructure. Even
though the fall of real spending in social areas after
independence was
reversed in the late nineties, important effects on the supply
quality of health services and on the demand for health care
were observed. The declining quality of services associated
with lower wages, lack of drugs and deteriorated
infrastructure was accompanied by a significant decline in
the number of patients and increased informal payments.
A second dimension is the market-oriented reform in
the health sector, which involved a
decentralization process and privatizations of some
components of the system. Hospitals and
polyclinics were converted into semi-private enterprises and
the management of health care
providers was decentralized allowing them to fix their
health service prices, choose their mix

36 | P a g e
between medical and administrative personnel, and allocate
resources accordingly. In 1993 state health care institutions
became state health enterprises, or semi-independent units
that could generate their own revenues parallel to state
budget financing. In 1995 hospitals and polyclinics were
permitted to provide private services in addition to state
funded ones, providing them
additional autonomy with self-decision on staffing (World
Bank 2002a). The separation between health care delivery
and financing was established through the creation of the
State Health
Agency (SHA) in 1998, responsible for purchasing services
to providers (hospitals). In order to contract out services a
Basic Benefit Package was established.
The changes during the nineties represented the actual elimination
of former free
universal health care coverage since those allowed
providers to generate their own revenues
through OOP. As a result, the increased incidence of
out-of-pocket expenditures -- and even
worse, that of informal payments to medical and
administrative staff -- resulted in decreased
health care utilization, especially among the poor. To
respond, the government established a
program that provided free of charge medical services
based on two eligibility conditions:
(i) the patient belongs to some vulnerable socio-economic categories;
or
(ii) the medical care is qualified as urgent by the medical staff.
The definition of the vulnerable groups actually
corresponded to the system of categorical
social assistance benefits inherited from the former Soviet
Union. All costs of services (not
including medications) under the program for the Vulnerable
Population are covered by the
government and expected not to exceed 30 percent of the
providers total annual budget. All
other interventions are expected to be cover by the resources
generated by the providers.

_____________________________________________
_____________

US Healthcare reform: the economic effect

Publisher by: Tim Fernholz

Published: March 22, 2010
(Last modified: December
31, 2015 ) Retrieved-
February 12, 2016

37 | P a g e
Main Point:
While the healthcare bill is moderate in ambition
and scope, it will have far-reaching effects in the
public and private sector.

Aside from Democratic cheers, there was no immediate sign that

the passage of
healthcare reform last night will have a major impact. (No, the socialist
utopia has not yet
begun.) But, while the bill is moderate in ambition and
scope, it will have far-reaching, and, if you believe non-
partisan economists, ultimately beneficial effects on the
economy, in both the public and the private sector.
Perhaps most important in Washington is the budget picture.
Democrats wanted to
expand healthcare coverage to as much of the population as
they could, but insisted on making
sure the bill was deficit neutral. In fact, according to the
Congressional Budget Office, the bill
will reduce the deficit $143bn over 10 years, and could
reduce the budget deficit by one-half
percent of gross domestic product - a little over a trillion
dollars - in the next decade. Further,
the CBO has a history of underestimating healthcare cost
savings, so the numbers could improve
from there.
The bill will also act to lower the overall cost of healthcare through
a series of public
policy mechanisms within Medicare and Medicaid, ranging
from commissions to determine how
best to reimburse doctors to funding for research to find the
cheapest, most effective medical
procedures.
It also helps shape the private market with insurance exchanges
that improve
competition, taxes some expensive health plans to force
insurers and employers to negotiate better care, along with
other, more prosaic measures - investments in information
technology and prevention - to "bend the cost curve" down.
CBO believes that the plan will "substantially reduce the
growth of Medicare's payment rates for most services" and
"substantially reduce the cost of purchasing [health
coverage]" for families.
The bill will also have an effect on the labour market. If it helps cut
costs and reduce
premiums, we could see growth in wages for working people.
A variety of academic studies have
identified a connection between stagnant wages and
increasing insurance premiums; reversing
that trend could help drive up salaries. Further, and crucially,
the White House Council of
Economic Advisers believes the bill can create some 320,000
new jobs, increase GDP growth by

38 | P a g e
4% over the next 20 years, and increase average family income by $6,800
in the same period.
Healthcare economists David Cutler and Neeraj Sood think
the bill could create between 250,000 and 400,000 jobs a year
over the next decade.
The bill's proponents also point out that it will help
small businesses with tax credits that will ease the costs of
providing health insurance, and will spur entrepreneurialism
by eliminating "job lock" - when a person avoids pursuing
new opportunities in order to protect their employer-
sponsored healthcare coverage.
These are the arguments that reformers have been
making about the bill for ages. While some of the
Republican criticism is sheer demagoguery, and other
critiques mostly procedural hand-waving, some have made
points about concern that Congress won't follow through on

necessary future steps to preserve the savings in the bill.

However, as the Centre on Budget and Policy Priorities has
demonstrated, Congress has historically demonstrated a
willingness to
impose these savings in deficit reduction legislation from
1990, 1993, 1997 and in 2005.
Now that the bill is passed, we'll have the empirical
evidence to see whose claims about the bill turn out to be
true. Much like President Obama's other signature
legislative victory, last year's stimulus package, we'll likely
find that the data supports reformers' promises.
 And did I mention, the bill covers some 31 million
Americans who didn't have health insurance before? It's not
all dollars and cents, you know.
_____________________________________________
_____________

39 | P a g e