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posted 5 Jun 2014, 08:26 by Gerry Kangalee   [ updated 5 Jun 2014, 17:02 ]



The External Patients’ Programme, announced by Health Minister Fuad Khan, represents the formalization of the government policy of divestment of the health sector as the National Workers Union has been pointing out since then-Finance Minister Dookeran made it clear in a speech on Public Private Partnership at the Hyatt on Tuesday November 1st, 2011. The Minister spoke of privatising public utilities, ports, airports, health care provision and pensions.

What the External Patients Programme does is to institutionalise the scandalous situation existing in the health sector since the introduction of the Regional Health Authorities in the late 1990’s. For years public funds have been routed into the pockets of a clique of medical doctors masquerading as public officers in the public health system while actually operating a private hospital sector. 

Patients are routed through the public hospitals into the private hospital system and the government pays. This rapidly growing health sector cannot exist in its present form without being a parasite on the public health system. These medical crony capitalists, like their brethren in the manufacturing, construction and service sectors are leeching on the state in their mad scramble to accumulate capital at the expense of the public. That is why it is so important for the business elite to maintain control of the political parties. 

The External Patients Programme, according to Minister Khan, is designed to ensure that people who have to wait prolonged periods for appointments will be allowed to have the surgery or other procedures at private medical institutions. Khan argued that those who are to access private care must have been waiting in the public health system for more than three months. They would be given vouchers to go to private institutions. 

The National Workers Union’s information is that 99% of the external patients are in the system for longer than three months, so one can safely say that all the patients would be able to access this programme. What a great money-spinner that will be for the private medical capitalists! 

The backlog began because the Regional Health Authorities (RHA’s) are being purposely starved of equipment and staffing. In the North Central Regional Health Authority alone, there are, at least, six hundred and fifty vacancies to be filled. So the production capability must decrease, hence the reason almost all patients are in the system for longer than three months. The RHA’s suffer serious deficits in terms of equipment staff, medication, utensils and everyday products. 

Management of the RHA’s is based on political allegiance and not on providing a first class health service to the citizens. The industrial relations are abysmal and lead to low morale and frustration on the part of employees who are not connected to the party in power. Contract employment is the favoured form of employment and contracts are varied at will making these workers incapable of organising their business going forward in terms of bank loans, mortgages, significant investments etc. 

Because there are no recognised majority unions in the RHA’s, except for the Medical Professionals Association in the South West Regional Health Authority, compensation packages are falling behind and terms of work do not evolve to raise the standards of the conditions of work. Because of the political intervention in day to day operations of the RHA’s hiring and promotions are not transparent. Incompetent management and horrible industrial relations also contribute to the backlog. 

The minister admitted that there was unused capacity at public hospitals but “those who were supposed to do the normal work were not doing it and making sure that there was a backlog. So we are partnering with the private sector.” 

Does Minister Khan take the citizens of Trinidad and Tobago, his employers, for a nation of idiots? Who are these people making sure there is a backlog and what do they have to gain? Aren’t they the very people who operate in the public hospitals and run their own private facilities? They create the backlog in the public sector and the Minister’s solution is to reward them by handing over hundreds of millions of dollars to them to ease the backlog? What absolute rubbish! 

Minister Khan has not addressed the following key questions. How long will it take to decrease the backlog? After the backlog has decreased will the programme come to an end? Will the RHA's be given the correct amount of staffing and physical resources to prevent another backlog? What is the total estimated cost of this program in comparison with equipping the RHA's? How many of these private institutes are affiliated to friends and family of politicians? 

How come in 2012 Khan himself stated it was too costly to outsource medical procedures; stating in the Senate $164 million was spent for outsourcing services for the period 2009-2010, yet today he is institutionalizing outsourcing? On another occasion he said the exorbitant figures were forcing him to stop outsourcing to private hospitals except with the authority of the Minister or the Chief Medical Officer. Talk, they say, is cheap particularly when it comes from a Minister of Health who is himself a leading figure in the private medical sector.

The truth is that the health sector in T&T stinks. It has been a running sore on the body social for decades and it needs to be fixed. Handing over hundreds of millions to the medical mafia is not going to fix it. 

The External Patients Programme is a critical element in the further privatisation of health care and the eventual privatisation of public health care institutions by the powerful and influential medical mafia that is responsible for the high cost of health care and which will see further increases. 

The public health institutions seem set to become a gathering station for those in need of medical procedures. They will play the role of holding bays and clearing houses for the shunting of patients into the arms of the medical mafia. Of course, when the private hospitals run into problems they rush patients back to the public health institutions to die. 

The National Workers Union, unreservedly, condemns the establishment of the External Patients Programme and sees it as another trough for another group of parasites to eat a food as the elections draw near. This move is the final nail in the coffin to legitimise and officially sanction the well-orchestrated fraud long practiced by the greedy cabal of medical capitalists and is designed to advance the stated policy of the government to privatise health care provision.



Gerry Kangalee (National Education and Research Officer – Cell: 785-7637)

Gerry Kangalee,
5 Jun 2014, 08:26