By Anna Gaskell Observer Staff Writer (Charlestown, Nevis) – According to a trio of Nevisian healthcare experts, the current healthcare system on Nevis needs to change. It is in need of a financial overhaul to give it more stability and greater accessibility. Nevisians understand their own responsibilities to society, and are willing to contribute. The key obstacle to change is a lack of political will, say the healthcare experts. The healthcare experts interviewed for this article are: Permanent Secretary for Health, Jocelyn Liburd. Hospital Administrator at Alexandra Hospital, Veta Morton, Chief Medical Officer at Alexandra Hospital, Dr. Cardell “Bal” Rawlins. Q: What does “National Health Service” usually mean? A: The principle of a National Health Service, as stated by the NHS organisation in the United Kingdom, is to “provide quality care that meets the needs of everyone, is free at the point of need, and is based on a patient’s clinical need, not their ability to pay. The NHS will not exclude people because of their health status or ability to pay.” Other countries operate similar systems, but under different names. They are usually funded centrally from national taxation. Tuesday Online Code for Issue # 733 is QXP Q: Does Nevis have that kind of National Health Service? No. If a full National Health Service means free care for everybody, Nevis is “nearer to the bottom rather than the top” of the scale, according to Dr. Rawlins. But healthcare is free for local residents under the age of 16, and also for those over the age of 62. Nevis is able to offer this service due to heavy government subsidization (100 percent in the health clinics, and 92 percent in the Alexandra Hospital). Services provided by the health clinics, such as family planning and child welfare, are free but limited. More comprehensive care, such as radiological services and surgeries, is available at subsidized rates in the Alexandra Hospital. For example, while a surgeon charges a fee, which may be quite high, the patient still only pays a fixed rate: EC$100 for a minor surgery, EC $200 for a major one. Charges for a consultation with a doctor at the hospital are also offered at a fixed rate: EC$40 for a general practitioner, EC$60 for a specialist. Prescription drugs from the hospital pharmacy are available at EC$10 per unit, but supplies are often low. Q: So the government on Nevis does try to make healthcare affordable, though not free, for most people. But can it afford to continue subsidizing healthcare to the extent to which the public has gotten used to? A: Again, no. Ms. Morton, Ms. Liburd, and Dr. Rawlins all agree that the current system is not sustainable. Dr. Rawlins thinks Nevis must adopt something more like the UK system, which is funded by the public through taxation. He says that either such a system has to be set up now, or it will have to be set up later. It has to happen. He admits sadly that he thinks Nevis “won’t jump now,” but will “wait to be pushed later.” “Ms. Liburd worries that Nevisians expect the government to pay for everything. When she was Hospital Administrator at the Alexandra Hospital between 1996 and 2006, she tried to enforce certain regulations on the public’s access to the EC$10 per unit of prescription medicine, so that the low price would be available just for those who were patients at the hospital. As it is, everyone feels entitled to the cheap prescription medicines and consequently there is not enough to go round. Either prices will have to be raised to more realistic levels, which will probably cut those with low incomes out of the picture entirely, or a decent National Health Service must be set up on Nevis. Q: Can Nevis set up such a National Health Service? Yes, of course. Dr. Rawlins says that an “entity needs to be set up ” a health authority – which would work in conjunction with a service similar to the English one. The money to support it would come from a payroll deduction, deducted from everyone, with no exemptions.”” For the sake of simplification, Ms. Liburd says, “let’s call it a health insurance.” In the same way as those who get social security deducted from their wages have a social security I.D card; there could be a “Nevis Health Insurance” card. This card would be presented at hospital and other public health practices, and it would act as a passport to “free” healthcare. Recently, Dr. Rawlins has been talking to the public about this plan, and he found that the Nevisian public would be willing to pay a percentage (between 1 percent and 5 percent) of their wages towards a central health insurance. The “health authority” that Dr. Rawlins envisages would also make the system more efficient. They would have a clear budget with funds up front, which would enable them to know in advance exactly what services Nevis can afford to offer. Q: So what are the obstacles? A: “Political will,” says Ms. Liburd. Dr. Rawlins also says that the “politicians are wavering” on this. For the same reasons that politicians waver on most things: if it doesn’t work out immediately it will affect their popularity and they may not get re-elected. Q: What steps need to be taken to make the current situation better? A: Dr. Rawlins says that three things need attention now. Firstly, Nevis needs to be better at recruiting and retaining nurses and doctors. As it is now, two thirds of the nurses working at Alexandra Hospital have the right to retire (with a pension) at any moment of their choosing, because they have already worked as nurses there for 25 years. If they all decided, as is within their rights, to retire tomorrow, Nevis would have a crisis on its hands. 80 percent of the doctors working at the hospital are from abroad, and they may choose to move on to other countries. Training and recruiting local physicians will be essential. Secondly, Nevis needs to improve its diagnostic and treatment capabilities, by getting better more advanced equipment (and training people to operate and maintain such equipment). At the moment, Nevisians often have to go to other islands for certain forms of treatment, such as chemotherapy. This is another financial drain on the government, who are often asked to provide financial assistance for these trips abroad. Ms. Liburd says that instead of each small island competing for all the high-tech equipment and for every kind of specialist, there should be “centres of excellence” in the Caribbean. Each island would be a “hub” for certain medical services. The money not spent buying the whole range of expensive equipment for every island could instead be used to pay for travel costs between the islands. If each island is recognised as having its particular strength in one or two medical fields, that fact alone would attract the best specialists to the places where their expertise are required. Finally, the healthcare system needs financial investment. “The funds have to be sustainable,” says Ms. Morton.” None of the above can be achieved without money. And so again we arrive at the same conclusion: the need for a scheme that would create funds and lessen the burden on government coffers.”