Guyana should be aiming to have many specialty units

Apr 25, 2014 Features / Columnists, Peeping Tom

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The Specialty Hospital has been given special treatment by the combined parliamentary opposition. Once again, the plug on the finances for the construction of this hospital has been pulled.
The opposition parties are yet to give an explanation as to why financing for this project was not approved. But it comes against the background of a Guyanese man dying in Trinidad after he began feeling unwell.
In this instance the man was said to be on holiday in the twin-island Republic, but a great many Guyanese have gone to Trinidad to seek tertiary medical treatment at specialized institutions.
The trend these days is to have specialized institutions that provide tertiary medical care. It is felt that a better service can be provided if it is delinked from the provision of primary health care.
One of APNU’s parliamentarians had argued during the Budget debate for the upgrading of the Georgetown Public Hospital Corporation. The plea was that instead of having a specialty hospital, it would be much better if the Georgetown Public Hospital could provide the same services provided by the proposed Specialty Hospital.
There are number of challenges in doing so. First of all, as mentioned, the experience has been that it is best if tertiary care is provided by specialized institutions. Even where such care is provided in institutions that also provide primary health care, it is usually done under independent units. This is the reason why, for example, the Caribbean Heart Institute is a separately-run facility operating out of the Georgetown Hospital. However, it is a privately-operated service.
A second reason why specialty hospitals are needed is because of the prohibitive costs of tertiary health care. It would be unaffordable for the Guyana government to provide tertiary health care free of cost. Certain surgeries require specialists to be brought in; require certain procedures which are not only costly but which have to be carried out without any threat of other demands for use of operating facilities. You don’t expect, for example, when someone is being readied for open heart surgery, to be told that they will have to wait because there was a major accident somewhere and that preference for the use of operating theatres has to be given to the injured from the accident. With specialty hospitals, there is no fear of this happening.
But fundamentally, the reason why governments are moving towards specialty hospitals is because it allows them to provide their citizens with a much needed service, one that is less than the cost of similar services overseas. If Guyanese, for example, had to go overseas to obtain open–heart surgeries such as that which is provided by the Caribbean Heart Institute, it would cost ten times what it is costing them at the moment. As such, specialty hospitals allow for far cheaper access to certain types of health services.
But because this is not a free service, there is a problem. Vested interests see the opportunity that has arisen because of the need for specialty hospitals as a means of making money. Such hospitals, while providing cheaper health care in developing countries, have become a money-making investment.
This is something that has to be guarded against, because there are strong concerns over the use of taxpayers’ funds to be invested to allow private medical practitioners and even private investors to profit. The Specialty Hospital that the Guyana government wants to construct can allow for certain persons to make money. It can become a gravy train for them to profit off of a massive state investment.
But the solution to this problem is not to abandon the idea of having specialty hospitals. The solution should be to use the profit motive to secure tertiary health care. One way in which this can be done is to encourage private hospitals to provide such care. There are many private hospitals which are at the moment competing with the public health care system in the provision of primary health care. These private hospitals should be encouraged and offered incentives to provide certain specialized services, both secondary health care and tertiary health care.
In this way, the profit motive which is often essential in ensuring quality health care can be directed towards ensuring that the public has access to health care. Thus, for example, a patient in need of a kidney transplant can be referred to a private hospital for such treatment.  In this way you build local capacity without the government having to get directly involved in providing the service.
Instead of having one specialty hospital, Guyana should be aiming to have many specialty units, each providing a specific health service, and each being run privately. This is the way to go.

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