1 week ago
8
T he Gleaner letter writer of the day, Fr Donald Chambers, posed important questions on August 13 in the context of speeches made at the groundbreaking for The University Hospital of the West Indies’ (UHWI’s) US$80 million, six-storey, state-of-the-art building project.
Which of the speakers, who he called by name, experienced UHWI’s Accident and Emergency Department or navigated the hospital management systems? Had they endured the excruciating wait – eight hours or more – for an elderly relative to get medical attention?
The institutional response was deafening silence. One interpretation is that it will be the ‘same old, same old’, despite the promise of ‘world-class medical care’ and a gleaming new tower, or that the ‘suits’ who spoke do not have satisfactory answers to the clergyman’s questions.
Small, consistent, people-centred actions, a genuine commitment to care, ongoing maintenance, responsive customer service, and management systems that treat patients with dignity, clean bathrooms, clear communication, efficient processes, and reasonable waiting times, the Roman Catholic priest argued, are some of the things that should be part of the discussions about the execution of the project.
Tom Peters and Robert H. Waterman, in their 1982 classic, In Search of Excellence: Lessons from America’s Best Run Companies, popularised the concept: management by walking about, a hands-on leadership style where leaders and managers regularly and informally walk through their workplaces to engage directly with employees and customers, observe operations, and gather real-time feedback. They do not rely solely on reports or meetings.
The concept emphasises spontaneous, face-to-face interactions that build trust, improve communication, and foster a deeper understanding of day-to-day challenges. Management by walking about does not appear to be part of the UHWI medical chief of staff’s day-to-day functions.
Private sector companies, with few exceptions, suffer from the same service faults as the UHWI. When was the last time you saw the CEO of a bank or an insurance company walking through the premises examining the business processes in real time through the eyes of customers? My encounters with the local health insurance claims advice/claims processing process have led me to conclude that CEOs are not close to the action, and seldom understand the frustrations of ordinary folks.
Given the shortcomings of the public health system that Fr Chambers described, private health insurance plans marketed as providing employees with choices are not panaceas. The options are limited because of the few private hospitals and three health insurance providers. Additionally, many persons, including human resource management specialists and even insurance company employees, are ignorant about the terms of the coverage.
Private health insurance, like everything else, has pluses and minuses. The healthcare needs of employees and their families, and their financial situation are often not catered for. The solutions are ‘one size fits all’.
Also, many people are unaware that funding, in the form of subsidies for some medications are provided by the government under the National Insurance Fund.
Pros of private health insurance:
• Reduced waiting times: quicker access to specialists, elective procedures, and diagnostic tests as compared to public hospitals and clinics;
• Choice of providers: beneficiaries can select preferred doctors, hospitals, and specialists;
• Comfort and privacy: access to private and semi-private rooms and facilities can improve the overall healthcare experience, during hospital stays; and
• Tailored plans: programmes can be chosen that match lifestyle, age, and health needs, with add-ons for maternity, chronic conditions, or international coverage.
Cons of private health insurance:
• High costs: premiums, deductibles, and co-pays can be expensive, especially for comprehensive coverage;
• Complexity: understanding policy terms, exclusions, and claim procedures can be confusing and time-consuming;
• Coverage limitations: some treatments or medications may not be covered, or may require pre-authorisation, leading to long delays or out-of-pocket expenses; and
• Inequity in access: It creates a two-tier system where those with private insurance receive faster or better care than those relying on public services.
Studies conducted in the United States have found that, even with insurance, medical expenses can result in two out of every three personal bankruptcies. Understanding what is covered and what is excluded from the coverage is very important. Here are some lessons that I have learned:
Health insurance should always be regarded as Plan B, not Plan A. Be prepared to fund treatment out of your own pocket, especially in the case of emergency treatment.
The claims process is opaque, unfriendly, arbitrary, and designed to save the insurer money and not to provide medical care to policyholders.
The insurance regulator has not developed any specific rules about how health insurance claims should be managed.
While court rulings are subject to review by higher courts, health insurance claims decisions are, in practice, seldom the subject of arbitration or review by the Appeal Court or Supreme Court.
Claims should be submitted to the insurer within a period of 90 days after the expenses were incurred.
Access to proper health insurance – and, more broadly, healthcare – is widely recognised by international bodies and human rights organisations as a human right. Cuba, Canada, the United Kingdom, and the Scandinavian countries built their healthcare systems on this philosophy.
We in Jamaica continue to treat it as a market commodity, like the Americans. This is the root of the problem.
Cedric E. Stephens provides independent information and advice about the management of risks and insurance. For free information or counsel, write to: aegis@flowja.com or business@gleanerjm.com
English (US) ·