The Ministry diagnoses the wrong disease

Sep 02, 2026 Features / Columnists, Peeping Tom

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(Kaieteur News) – The Ministry of Health’s response to Peeping Tom’s column, “Second-Class Patients,” is a case whereby a medical response is so clinically misplaced that one is tempted to prescribe a second opinion.

The Ministry has produced an impressive medical case for something nobody was disputing. It explains screening, early detection, clinical urgency, emergency testing, inpatient care, maternity services, intensive care and surgical priorities. It then proceeds to administer a therapeutic dose of statistics about vouchers, laboratory tests, angiograms, stents, pacemakers, dialysis and other accomplishments.

Unfortunately, it has diagnosed the wrong disease.

Peeping Tom never said that Guyanese are “second-class patients.” What was said was that patients were being treated as second-class by virtue of the manner in which their treatment was handled when they had to pay with a government-issued voucher. The complaint was that a private hospital had reportedly displayed a sign informing persons using government-issued health vouchers to return the following day for their laboratory results. The issue, therefore, was not whether the particular tests were emergencies. It was not whether an intensive-care patient should receive priority over somebody undergoing routine screening. Nobody suggested anything so medically absurd.

The issue was whether voucher patients, as a class, were subject to a different turnaround policy from patients paying privately. And here the Ministry’s elaborate clinical differential diagnosis becomes irrelevant. If the policy is that a person presenting a government voucher must wait 24 hours for a result while a cash-paying patient receives the result sooner, then the question is not one of clinical triage. It is one of different standards – one for the cash paying patient and the other for those paying using government-issued vouchers.

The Ministry can explain all it wants that not all laboratory investigations have the same clinical urgency. Fine. That is Medicine 101. But it does not answer the question raised by Peeping Tom: Are patients at this hospital and who knows at possibly others receiving differential treatment because of the method of payment?

If the answer is yes, then the Ministry has a problem. The Ministry should visit the private institutions participating in the voucher programme and determine whether voucher patients are receiving the same standard of service as patients who walk through the door with cash, a credit card or private insurance. After all, the government is not giving these private institutions charity. It is giving them business. The voucher represents public money being transferred to private healthcare providers. The least the State should demand is that a patient whose bill is being paid by the State receives the same timely service as the patient paying with cash.

The Ministry’s response then wanders into a recital of the 646,000 persons who have benefited from voucher services and the billions invested in GPHC and other public facilities. These may all be commendable achievements. But again, they do not answer the complaint. A patient cannot be cured of differential treatment by being presented with a spreadsheet. Nor does citing the number of angiograms performed at GPHC establish that every regional hospital has adequate emergency capacity. By the way, is that service free and immediate? Nor does citing the number of pacemakers inserted at Georgetown Public Hospital not answer why a critically ill patient admitted to one of the new regional hospitals may still have to be transferred elsewhere.

That was the second point being made: government is spending billions expanding public healthcare infrastructure while simultaneously using substantial public resources to purchase capacity from private institutions. Yet, when serious cases arise, some patients may still have to be referred because the institution to which they were taken lacks the requisite capacity.

Referral is, of course, perfectly legitimate where a patient requires a higher level of specialised care. No sensible person disputes that. The question is whether referrals are occurring because of an appropriate clinical hierarch or because the first institution lacks equipment, specialists, intensive-care capacity or other essential resources.

Then there is the third point, which the Ministry also manages to avoid. A poor Guyanese who cannot obtain specialised treatment through the public system may be directed to a private institution, only to discover that the cost of continuing treatment is beyond the family’s means. The result can be the most humiliating discharge of all: the patient leaves not because the patient has recovered, but because the money has run out.

That is not a question of preventive medicine. It is a question of health-system capacity and equity. And that is why a case can be made for using the resources of the voucher system and plugging those resources to build greater capacity in the public health system. The Ministry would therefore do itself a favour by putting away the stethoscope for a moment and reading the column again. The issue was not whether vouchers have public-health value. Nor was it whether emergency patients deserve priority. Of course they do. The issue is whether a government-funded patient is entitled to the same standard of service as a privately paying patient. And why should persons be forced to take a discharge at a private hospital for a service that they cannot receive in a timely manner from a public hospital. And why recently someone was rushed to the Port Mourant Hospital after an accident and had to be transferred to the New Amsterdam hospital, and died enroute.

(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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• diagnoses, ministry, Peeping Tom, wrong disease

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