National healthcare systems

Countries in the Caribbean region lack economies of scale for a healthcare system the country really needs. Therefore, the health care expenditures per capita are higher than acceptable resulting in considerable pressure on available financial resources, at national level as well as for the individual. It is very important to minimize the potential burden of disease and care. However, one should not be too optimistic. The total health care expenditures will certainly increase in the future as a result of demographic change (aging of the population), the increasingly unhealthy lifestyle and technological developments. These developments are partly autonomous and cannot easily be stopped. Moreover, apart from an unhealthy lifestyle, these developments are merits rather than problems for our society. So we have to accept, or maybe even hope that we spend more on health care. But there is a critical need to rationalize costs and avoidable expenses, for example by preventing wrongful use of facilities, and avoiding inefficiency and avoidable complications and unnecessary medical interventions.

When rationalizing health care, expenditures are seen as an investment in order to ensure and encourage the health of the population rather than to spend reactive on expenses for illness. The spending by investments are to be judged on the value they provide and they are not merely considered as a cut cost. When rationalizing healthcare spending, one must keep in mind that there are many perspectives regarding health care expenditures:

  • The national healthcare expenditure under the national budget;
  • The cost to the government, health insurers, employers, healthcare providers and patients;
  • The premiums are paid by contributors to health insurers;
  • A source of income for healthcare providers and – institutes;
  • The disease burden and the quality, costs and benefits of care.

There should be a complete balance between these perspectives. An imbalance can lead to: (potential) shortages at government level, high premiums with loss of purchasing power of the population, exploitation problems for healthcare providers, practices and/or institutions by low-income or high costs, avoidable costs and complications due to under- or over-consumption, and/or high or increasing burden of disease due to inadequate care. If there is an imbalance, the accessibility, quality, continuity and outcomes of care are in danger.

In an optimal functioning health care system, the health care needs of and for the entire population is adequately and effectively completed, with equal access for all rightholders. Adequately means that the quality and quantity of care has to match the demand for care, provide optimal care results and prevent avoidable healthcare problems. Effectively implies that it is ensured that the care budget is optimally utilized. Ultimately, there must be a balance between the expenditure incurred on healthcare and the demand for healthcare. In addition, this must remain sustainably affordable. ACSION has supported several governments with formulating and implementing their strategic framework for major health system reform. Our support introduce an integrated programmatic approach is, which allows to pick up all aspects of the reforms directed and in phases. At the same time attention is given to the change management to ensure tranquility and adoption by all stakeholders.

Example: Curacao, St. Maarten and Surinam