The medical costs of treating the population in every country have been gradually rising due to an increase in workplace accidents and episodes of various diseases, including communicable and non-communicable diseases, vector-borne diseases, degenerative diseases, genetic diseases, environmental diseases, and lifestyle-related diseases.
The advancement in science, technology, use of modern technical devices in every trade has led to high risks of accidents that require sophisticated medical attention and treatment. There are many types of traditional medicines used by ethnic groups worldwide. In many cases, the medical practitioners may have difficulties in detecting and treating complicated medical cases, which may not be possible to treat soon.
Nevertheless, the use of digital software, and numerous medical examinations and tests, such as blood pressure, sugar, urine, X-rays, CT Scan, and observations (ICU-O), and admission in hospitals for a few weeks, may give an idea of the case history.
Numerous preliminary tests, medical examinations and professional attention are required, which may at times require experts for confirmation. In many instances, patients die before their treatment can be completed. It becomes burden to families who may not be that rich to pay the costs to experts and hospitals. Even the rich family feel the sad loss as a tragedy since it’s not always about money loss, but the time spent with the patient, organising and other logistics, and a few may be away from home. So it is so hard to embrace the loss to see death while undergoing treatment.
In some instances, patients are taken away from the country. Families have to undergo the same ordeal and other inconveniences. It must be categorically stated that a few diseases may not be treated at all as it may have been less likely to be cured, including cancer, AIDS, diabetes and epilepsy. In addition, there are many others in the list (Langtree 2021).
Young and old patients — treatments
The ages of patients are another prime consideration when they are subject to medical treatment. This has resulted in a steady but gradual increase in global healthcare expenditure as a share of world income over the last couple of decades.
Moreover, there has been substantial cross-country heterogeneity, both in levels and trends. Regionally, high-income countries spend — and have been paying — a much larger share of their income on healthcare than low-income countries (about twice as much).
Moreover, in contrast to high-income countries, the public share of healthcare funding in low and middle-income countries is much lower — although it has been increasing — and the role of out-of-pocket expenditures is significantly higher (above 50 per cent of total spending in many countries).
Healthcare financing by the government and other agencies in developing countries in the 21st century has been largely shaped by the flow of resources channelled through development assistance.
These flows – which saw a steep increase after the introduction of the Millennium Development Goals, 2000 – account for around 0.7 per cent of the resources spent by high-income countries on healthcare. Although this may seem small in proportion to the national commitments of rich countries, for low-income countries at the receiving end of the transfers, these resources are substantial.
This implies that development assistance for health, if suitably targeted and managed, has the potential of drastically reducing inequality in health outcomes: the robust empirically observed relationship between health outcomes and healthcare spending is indicative of large returns to healthcare investments, particularly at low levels of baseline expenditure.
Fiji’s case
While basic medical treatment in all the government’s medical clinics is free except for certain specialised treatments, such as dental fees, and for some service charges. We know people are living longer in Fiji: average life expectancy in Fiji rose from 65.5 years in 1990 to 70.4 years in 2017. However, we have a young population: 54 per cent of people in 2017 were under 30 years old. 14.3 per cent of people experience disabilities.
The population is also rapidly becoming more urban, especially in the Greater Suva area, increasing demand for services (Bureau of Statistics, 2018). Many services are also being decentralised and operated through special outpatient departments (SOPDs) and general outpatient department functions.
An important feature of the improved continuum of care has been the multidisciplinary teams conducting outreach in communities, in collaboration with community health workers (CHWs).
The Fijian population is able to access medical services for free or at very low cost. We know that in Fiji, our services are poor and generally equitable.
To help low and middle-income Fijians, the Free Medicine Policy has had great success in ensuring the poorest households can offset redeem the costs of medicines purchased from private pharmacies if not available from the government pharmacy. Public spending on health has increased to 3.1 per cent of Fiji’s GDP.
About 43 per cent of government health spending between 2011 and 2015 was on hospital services (MHMS,2017).
The Ministry of Health has been allocated a total of $540 million in the new budget.
Former finance minister Professor Biman Prasad says $450m has been allocated to the Ministry and $90m for the running of the Ba and the Lautoka Hospitals, which are under the Public Private Partnership arrangement.
However, the allocated budget has not been sufficient due to high costs in serving a vast population and other medical costs.
Aspen Hospital at Ba and Lautoka has been tasked to take care of medical care at both districts, as done by the Ministry of Health over many years.
This is a new initiative under Public Public-Private Partnership Deal with Aspen Medical. The costs are $10m per month.
These two hospitals consume more than one-fifth of the national health budget, according to the former finance minister.
It may mean the ‘user’s pay’ may be the other option. In many instances, the government pharmacy does not have adequate medicines for the patients.
The patient should shave to purchase them from the local pharmacy. Despite arrangements and support from the private pharmacies, at times, medicines are not provided under such a scheme.
The poor patients have to spend their pocket money on their medical needs.
Brief discussion on health expenditures
Table 1
There are 42 countries which may be classified as low-income earners to high-income earners, which include Mexico, Turkey, and Colombia, while the high-income earners include Australia, Sweden, Germany, Canada, the UK, and the USA (Table 1).
The Government bears a vast majority of medical costs; on the other hand, many workers also pay insurance to cover their medical costs.
These costs are much higher, ranging from 5k to 10k (Table 2). A sum of roughly $200.00 per person has been indicated for a year in Fiji.
While this amount may be reasonable to some, however, some conditions affecting a person (of any age) may be inadequate.
There are numerous hidden costs incurred in the treatment of any person, be it a child or an elderly patient. Many depend on the type of sickness and treatment provided, either at public or private hospitals.
These days, caregivers are required to look after patients in the evening at government hospitals. If required, a family member may be hired and provide care and attention at night.
Treatment of any patient admitted or requiring regular medical attention is not an easy way out for most poor families in Fiji. Some affected have to borrow funds for the treatment, even for local medical treatment. Some areas of budget required are: transport, medicines, hiring people, food and accommodation and attending special clinics after discharge. If a patient is a worker or a school student, there will be a possible loss of income and poor exam results.
In a particular case, India is much cheaper than Fiji (Table 1), and Vanuatu in terms of medical treatment. In Fiji, a vast majority of workers earn (salary and wages) less than $20,000 (FBS, 2021). Those who are rich will prefer to seek medical attention from their family doctors or private hospitals.
The Health Ministry also provide relief to those patients earning collectively less than 50k.
Moreover, families may collect public funds in various ways to support tertiary treatment overseas. Sadly, some patients die while receiving medical attention in other countries. The families have to bring the deceased back home for burial.
Conclusion
The fact remains that rich patients will always try to consult highly qualified medical professionals and may visit the public facility for many reasons. We may respect their personal choices.
On the other hand, middle-class and poor people may not afford such a facility; however, there are choices. Such as support from other families may be a hope to help such a patient. There are many instances of support provided by close relatives who live overseas and tend to provide much-needed assistance.
On the other hand, many patients are compelled to seek medical attention at their nearest medical health center provided by the Ministry of Health and Medical Services based on their preference. The worst scenario is that all patients are the mercy of almighty as everyone has to die, whether a person may be sick or healthy.
On the contrary, certain health conditions or sicknesses are beyond the scope of treatment due to many factors.
One may be born rich and may live longer; on the contrary poor may depend on the mercy of families and friends.
This is evident in rich countries due to good social and medical attention given to the senior citizens under special conditions, such as social insurance and social assistance(Yukoburi,2023).
During hard times, support from families and friends is encouraged as part of the Pacific cultural life. Hope to see all live long and do bother to look after your own health. May Almighty bless you with long lives.
- KESHWA NAND KRISHNA is a retired public health lecturer at the Fiji National University. The views expressed in this article are the author’s and do not reflect the views of this newspaper.
