From Awareness Times Newspaper in Freetown

Free Medical Services: Good Game But Poor Results
By Jia Kangbai
May 19, 2010, 11:44

So much for the  free medical services being offered to pregnant, lactating mothers and under five children. So much for the salary that was top-upped for health care service providers for this new health intervention. So much for the hue and cry at least for now. 

The most important and prudent question now to ask is: Will this free health care service offered nationwide be practical and sustainable in the long run?

Dont get me wrong. This is not a jihad against the government-sponsored free medical services. Everyone craves for freebies and goodies. But is there really anything that were freely obtained during our existence here?  

Nothing is free in this world-nothing; not even the air we breathe for which someone is paying for to keep it clean.  

The cost for this new health care intervention in Sierra Leone is costing someone (average British tax payers in the Sierra Leonean scenario) who pays for it in colossal sums of foreign exchange. 

Even the so-called Beveridge health system that is hyped to be the most effective health care system wherein as long as you are a national of the covered country as is practiced through the National Health System NHS in the UK is not free in practicality.

The British taxpayers objective (this is my hypothesis) is to have Sierra Leonean women enjoy better womanhood and to have the lives of their under fives flourish.

Alas here is a local problem now catching international consideration-it really seems some people way back in their  backyards in Europe have now grown concern for Sierra Leones appalling maternal and infant mortality rates.

While the expected health outcomes are optimistic for this free medical services (at least in the short run)-reduction in maternal and infant mortality statistics; one really wanders whether the flip side of the coin was ever taken into recognition in terms of the programs long term achievement.

In public health, any health intervention including clinical trials introduced in a health system is bound to produce a pair of outcomes; positive and negative outcomes and based on the assessment of such  (both tangible and intangible outcomes) outcomes decision could be based as to whether the new intervention will be adopted over the gold standard or orthodox treatment.

It should be agreed from the onset that the new free health care service has offered a new payment rate or system within the national health care system with general practitioners, nurses and other health care service providers having their salaries almost quadrupled in a fortnight.

Like any peripheral economics branch including public health economics, when there is an introduction of a new payment rate or system there is bound to be a shift in the supply and demand curves for that goods and services in consideration.

For a particular health care service, payment methods and health care accessibility are not the only factors that determines the demand for such services at all.

Health care payment plan affects the supply of health care service more than the demand in the long run than in the short run, while the same change in payment plan affects demand more in the short run than in future.

The government of Sierra Leones meth­od of setting salaries for health care providers administratively and without the invisible hand of the Pareto influence, and  by extension paying for the health care services of maternal, lactating mothers and under five children is no exemption to this global economics maxim.

Administrative price and payment fixing as was recently done will invariably affect the sup­ply of these health care services by influencing the decisions our medical doctors, nurses and other health care personnel make in relation to how many patients to serve for the day and which treatments their patients will receive.

The medical profession is one that greatly suffers from asymmetrical information with medical personnel in possession of mass of information compared to their patients.

And because of the central role that doctors and hospitals play in pro­viding health care services worldwide, their future output in relation to the ongoing new health intervention will be quick to deduce.

What will come into operation shortly is referred to as up-coding in public health financing wherein medical personnel will meet few patients a day but recording them as complex cases thereby recording long treatment duration on their behalf.

So succinctly put, the free medical health program has succeeded in putting into the pockets of our health care service providers huge sums of money for doing the same piece of work for the same duration. 

There has not being an extension of working period following the introduction of this new health intervention. But from all indications, the government expects our health care professionals to extend their working hours at least as a sign of patriotism, and respect for moral and ethics.

But there is little or no ethics and mores when one consider a profession as greedy and unethical as health care profession.

This fact is uncontested since the new payment structure doesnt warrant these medicos to extend their working duration beyond the pre-free medical era and even if they are forced to extend such daily tenure of service these medicos can still circumvent excuses of  fear for becoming inefficiency to have an escape.

So far so good for the possible future response of our health professionals as far as this new health plan is concerned. What is then the potential outcome and response of the consumers i.e. lactating and pregnant mothers and the rather unconscious under fives in this scenario.

This text will consider less about the possible outcomes or response on the part of the under fives. In the short run the nation will record a reduction in the prevalent rates for many tropical infections registered for Under five children ceteris paribus.

Such reduction when factored accurately will also be reflected in the reduction in the infant mortality rate-at least in the short run.

In the short run also, Sierra Leonean women will enjoyed a long life expectancy as well as a high disability and disease free life expectancies-two health gaps and health expectancies measures that are responsible for the poor rating of Sierra Leone in the annual Human Development Index.

In the long run the benefits obtained in the short run will boomerang as a result of what is potentially expected in the long run. In the long run, pregnant rate will almost quadrupled as Sierra Leonean women becomes more fecund. More under fives will be produced and the national carrying capacity (the total number of population nature can support) will be severely and negatively affected.

Our medicos will become tired with the heavy work load,  local feeding resources will now be overstretched. And this coupled with the high illiterate rate especially among rural Sierra Leonean women, the short term gains following the introduction of the free medical service will be visibly eroded.  


Jia Kangbai lectures public health economics and other public health courses at the Department of Environmental Health Sciences at the School of Community Health Sciences, Njala University. His specialties are public health economics and financing, and tropical infections.



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