A major shift in how Saint Lucians pay for healthcare is being proposed as part of the country’s Universal Health Coverage (UHC) Financing Policy, with consultants pushing for a consolidated system to reduce out-of-pocket expenses and improve access to quality care.
On Friday, the Ministry of Health provided a look into its stakeholder consultations, streaming a session between Joint Independent Provider Association (JIPA) Network consultants and credit union leaders. The discussions focused on JIPA’s financial strategy, which aims to alleviate healthcare challenges by creating a structured payment model and integrating the public and private healthcare sectors.
Dr Kester Nedd, CEO of JIPA Network, provided an in-depth presentation to credit union stakeholders on the conceptualisation and proposed implementation of the UHC Financial Policy.
He highlighted Saint Lucia’s healthcare system’s pain points, including a lack of integration between stakeholders.
“You have the public system over here, and then the private system over there… In many ways, we are siloed,” Nedd said. “Sometimes competition is good; other times, competition is not so good because we dilute ourselves in a way that we cannot reach economies of scale and we lack efficiency.”
Other concerns highlighted included the public system’s inability to provide all necessary services, a paper-based healthcare system that results in increased costs, and a tendency to implement short-term solutions to healthcare setbacks instead of more sustainable approaches.
Nedd further asserted that many of the illnesses locals are prone to developing are not included in premiums and that while some illnesses are covered via insurance, on average, only 12.2 per cent of the population has healthcare coverage, leaving most to pay out-of-pocket or rely on the government.
JIPA’s proposed financial policy features several attributes to address these shortcomings. The plan includes strategies like organising all healthcare providers under a network of independent providers who can contract with the UHC authority to provide services; bringing together all entities responsible for healthcare payments under a model JIPA refers to as Stratified Pool Risk Coverage (SPRC), featuring a structured payment system that pools people together; and addressing the current economic model. Currently, in Caribbean countries like Saint Lucia, 37 cents of every dollar spent on healthcare comes directly from citizens’ pockets, compared to just 3-7 per cent in other countries, according to Nedd.
JIPA’s VP of Operations, Kesan Buddy, explained, “The key here is when we’re talking about the distribution of that cost… we’re talking about changing the distribution of who pays for it. Right now, 37 cents of every dollar towards healthcare comes out of your pocket, and we’re talking about shifting that percentage, finding ways to have payers participate in distributing that cost among the population so it’s not a burden to each individual.”
According to Nedd, similar consolidation approaches have been applied in places like Miami, where he has worked, particularly at the Jackson Memorial Hospital—a public institution—which is supported by Miami-Dade County—a government institution.
“You ask yourself, how could a county institution that’s run by a government be able to achieve where a prince, a prime minister, the wealthiest people in the world get cared for, and the poorest guy on the street, all in the same place? Guess what they did? Consolidate—bringing together the private and public environment to operate in agreements that allow the system to thrive and make it fair for everybody.”
According to Alisha Eugene-Ford, Director of UHC with the Ministry of Health, “UHC is aimed at increasing access to quality health services, ensuring little or no out-of-pocket expenditure.”
She explained that UHC implementation is being carried out via a phased approach with an overarching goal of making a broad range of health services available to Saint Lucians.
The Ministry of Health launched Phase One of UHC in the summer of 2023. This included the rollout of hypertension and diabetes screening and treatment, maternal and child health services, cervical cancer screenings, and HPV testing in up to 17 rural areas, as well as the facilitation of a men’s health clinic.
“JIPA was brought on because we needed technical assistance to be able to work and to deliver on the UHC financing, and they have the expertise to do so. Therefore, they’re contracted to work alongside us at the Ministry of Health,” Eugene-Ford said.
JIPA has now conducted 13 consultations with local stakeholders, including doctors, unions, and policymakers. Once the consultation phase is complete, a plan will be presented to the Cabinet and later submitted to the Attorney General’s Office for legislation to be drafted.
