Second-class patients

Aug 28, 2026 Features / Columnists, Peeping Tom

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(Kaieteur News) – There is something wonderfully modern about a health system in which the government pays a private hospital to provide a service to poor people, and the private hospital then tells those poor people to come back tomorrow for the results. It is almost as if the voucher comes with a small footnote saying: “Congratulations, you qualify for medical care, but unfortunately you do not qualify for the same speed of service as everybody else.”

A sign at a private hospital reportedly informed persons using government-issued health vouchers that they should return the following day to collect their laboratory results. The hospital was, in effect, saying that its own paying patients deserved priority, while the patients whose bills were being paid by the government could practise the ancient medical art of waiting.

But this raises an embarrassing question: If the government money is bringing business to a private health provider, why should the people whose care is being financed by that money be treated as second-class customers? The voucher may be issued by the government, but apparently it does not come with a fast-pass for the laboratory.

Perhaps we should introduce a new category of health care called “voucher medicine,” in which the patient gets the test today, the result tomorrow and, if the illness is sufficiently serious, the diagnosis whenever everybody has finished having lunch. It would be funny if the consequences were not so serious. The larger problem, however, is not one sign at one private hospital but the philosophy behind the programme. When government repeatedly uses public money to purchase services from private providers because public institutions cannot meet the demand, sooner or later we have to ask why we are not using that same money to make the public institutions capable of meeting the demand.

There is something fundamentally wrong when the State becomes very efficient at writing cheques to private institutions while remaining less efficient at building more laboratories, operating theatres, diagnostic units and specialist services to further improve the public health system. If public laboratories cannot process the volume of tests required, then increase their capacity. Buy the equipment, expand the facilities, recruit and train the technicians and operate the laboratories for longer hours, rather than accepting the shortage as though it were an act of nature.

The same principle applies to specialised health care. Poor people should not have to choose between receiving life-saving treatment and keeping the family house, and they certainly should not have to experience the humiliation of being discharged from a private hospital because the family has run out of money. Imagine a patient is fighting for life while the relatives are fighting the bill. The disease is on one side and the accountant is on the other.

Specialised health care is not supposed to be a luxury. Oncology, cardiac care, nephrology, advanced surgery and other specialist services are essential parts of a serious health system, and they must be available to ordinary citizens in a timely manner.

We have made improvements in public health care – let no one deny that – and those improvements should be acknowledged. But improvement is not the same thing as adequacy, particularly when a patient can be rushed into one public hospital in a critical condition only to be told that the required treatment is available somewhere else.

Recently, a report in the media noted that an accident victim reportedly had to be transferred from the Port Mourant Public Hospital to New Amsterdam because his condition was so critical. He died while being transported. Nobody can say from one incident alone that the outcome would certainly have been different, but the incident forces us to ask an uncomfortable question: should our hospitals be referring critically injured patients because they genuinely need a higher level of care, or because the first hospital simply does not have the capacity to provide it?

This is precisely why investment in existing public hospitals matters. Before building a large number of new regional hospitals, government should ensure that the hospitals already serving the population have the equipment, specialists, laboratories, intensive-care facilities and emergency capacity necessary to save lives.

Government therefore needs to think beyond the immediate convenience of outsourcing health services. Every dollar spent purchasing private capacity should also prompt the question of whether that dollar could help build permanent public capacity that will serve thousands of people for years. There is nothing wrong with government partnering with private health providers when necessary. What is wrong is allowing such partnerships to become a substitute for building a public health system strong enough to stand on its own feet. The ultimate objective should not be to make government better at paying private hospitals to compensate for public deficiencies. It should be to make those deficiencies increasingly unnecessary, so that the next poor patient does not need a voucher, a mortgage, a miracle or a relative with money abroad just to get the health care that should be available as a matter of right.

(The views expressed in this article are those of the author and do not necessarily reflect the opinions of this newspaper.) 

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• Peeping Tom, private hospital, private institutions, Second-class patients

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