Healthcare in the Caribbean - Implementing Practical & Successful Long-Term Problem Solving Strategies

Ask many practicing public health professionals in the Caribbean (and North America) about the abundance of health models/theories versus the actual long-term practical problem solving success of any ongoing or current public health program/ mandate; and you would start what would likely end in a debate. The responses would likely depend on background, educational/ institutional affiliations, socio-economic level, and personal belief (including religion), present job satisfaction and personal experience with that specific issue or program. In the Caribbean therefore, the successful implementation (short-term and long-term problem solving success) of any ongoing or current public health program/ healthcare mandate requires that both national and locally established methods and definitions must comply with the spirit and intent of generally accepted international public health regulations. It does not require that exactly what was applied successfully in Canada and the United States must be copied and implemented unchanged. The combination of all the above, has lead to what amounts (over the past century of public health policies definitions and practice) to a generally self perpetuating array of analysis and counter analyses of accepted definitions and approaches and models. This has been a double-edged sword which when applied skillfully, improves the overall well-being of its target population and when poorly applied; could actually regress an already existing positive impact or at least greatly diminish expected positive outcomes. The efficient and strategic implementation of health models, public health programs and healthcare mandates would positively impact the previously highlighted "5 Major Factors impact Healthcare Delivery in the Caribbean" on the Bender-Grade for Health [BGH]: I. Island Politics, II. Island Population Size III. Percentage of that Island Population employed by the Hospitality IV. Time V. Type of Care needed

Healthcare in the Caribbean – A Perspective

Have you ever been to the Caribbean? Yes? Or are you planning a trip soon? To The Bahamas Islands maybe? Yes Sir/ Ma'am. The Bahamas is well known for its capital of Nassau, Paradise Island and Atlantis, Bimini, Abaco, Eleuthra and on and on……………… Could it be to St Lucia with its breathtaking views of the Gros Piton, Petit Piton, Pigeon Point and on to bathe in the Sulphur Springs? Saint Lucia being one of the few islands in the world that has its very own drive-in volcano. Jamaica? Hmmm… wonderful island and people. Yah Man. Montego Bay, Ocho Rios, Negril, Mandeville, "Out of Many, One People." Jamaica is really a great island to live in or visit, as long as you "behave" and follow island rules. What about Barbados, Trinidad and Tobago, Cuba, Martinique, Anguilla, Antigua, St Vincent and the Grenadines, ……………………? Obviously the list of very lovely island Caribbean destinations can't be easily exhausted. Most people do have the best of time as tourists/ visitors to the Caribbean, irrespective of where they chose to visit or live. A small minority will however have to seek some type of medical care at some point during their stay. Tourism is vital to many island economies and the economic importance of such is manifested in the attention successive governments give to the hospitality and health industry. By the way, why did you go? (Or why do you want to go?) Tourist? / Returning tourist? Honeymoon or wedding? Returning resident? Did you go to find work? (Or did you go as a tourist looking for work?) Were you just passing through on a cruise or thinking about establishing permanent residence on your island of choice? Could it even be that you chose your island because it's close to South Florida (Miami)? Maybe you are even a part of the steadily growing medical-tourism class? (where you combine cheaper or more private medical care/access along with viewing some of the most spectacular beaches and most tourist- friendly environments in the world). During your planned stay do you plan to indulge in "risky" or other routinely "uncharacteristic" behavior? Well, whatever your reason is, or is not, your healthcare provision should be its closely related cousin. I have been very privileged to have practiced medicine for several years in Jamaica, St Lucia and The Bahamas and many of its Family islands. It's also been an enriching experience to have been to Barbados several times as well as to Martinique, an overseas department of France in the eastern Caribbean Sea. Having also lived in South Florida (Miami) and Canada; it's pretty interesting to note some remarkable influences (positive and negative) that healthcare practices in the developed world has had on the Caribbean. It's further revealing to observe that there is a common cycle of political "under-spend to over-spend" regarding healthcare that is periodically seen in The US, Canada and its Caribbean neighbors. As mentioned earlier in IshMD's blog, generally, three major issues with healthcare anywhere in the world are centered on: Quality Access Affordability It's common place to underrate healthcare delivery in many parts of the Caribbean. Contrary to both local (internal) and foreign (external) perceptions and beliefs out there, many Caribbean nations actually have generally good health care systems in place. Once determined to be medically necessary, many islands also have relatively easy and efficient referrals and access to the US especially Miami; and to Martinique and Cuba. In addition, many of their physicians (foreign and local) and other categories of regulated health professions have practiced or maintain registration in more than one jurisdiction/ country. There is therefore a great exposure to quality and standard healthcare practices There are definitely some very sad and unfortunate instances whereby the healthcare system has significantly failed to deliver for clients; but I have learned that equally significant failures have occurred in many affluent and more developed countries. So you may ask, what factors significantly impact healthcare in many Caribbean nations? 5 Major Factors impact Healthcare Delivery in the Caribbean I. Island Politics (Government in power). Health and healthcare issues are very paramount in political debates, government allocation and funding; and as election result social determinants. While it is true that many incumbent governments have pushed for more "pay as you use" health policies, in practice and for political clout, most of the healthcare costs are heavily subsidized or fully borne by the government in power in various hybrids of National Health Schemes/ Insurance. Ultimately no one should be turned back due to an inability to pay for care. In this regard, virtually all Caribbean nations are basically the same; even though their can be a great difference in their GDP's. http://en.wikipedia.org/wiki/The_Bahamas http://en.wikipedia.org/wiki/Saint_Lucia http://en.wikipedia.org/wiki/Jamaica http://en.wikipedia.org/wiki/Cuba II. Island Population Size – more than 500,000 like Jamaica, Trinidad, Haiti or less than 500,000 like The Bahamas, St Lucia, Barbados. The smaller the island nation, the better the overall healthcare experience as in The Bahamas and Barbados or St Lucia. The larger the population size, the better the trauma care as in Jamaica and Trinidad & Tobago. Cuba should be noted as being an exception in this regard and many of its Caribbean neighbors have taken advantage of its health infrastructure. Cuba has consistently measured quite well internationally through the quality of its medical personnel and its universal free health care system. III. Percentage of that Island Population employed by the Hospitality Industry. The higher the percentage employed by tourism/ hospitality related sectors, the better the healthcare infrastructure, service, access and awareness. IV. Time. 1. The more the time self allotted by the patient to spend in obtaining care, the better the outcome. 2. The earlier in the condition/disease progression, the better. Do not delay in accessing care 3. The earlier in the day (from approx 8.00 am) that care is sought, the more proactive the access. V. Type of Care needed – (Emergent or Non Emergent, Private facility or Government facility). Government facilities are the best and fastest and more result oriented for emergent care - Trauma or Medical. This is because on most island nations, the best doctors usually work in dual modes simultaneously (private and public) and are usually obligated to be available for public emergent care. Based on the above five (5) parameters, I have formulated a grading scale/ system – Bender-Grade for Health [BGH] for any potential visitor/ resident in the Caribbean. My next posting will dwell on this and rate some islands based on their current/ past local situations. As in IshMD's blog, topical issues to follow also include: government's role in providing healthcare; hospitals, emergency departments and hospitalists physician practices, medical homes, urgent cares, minute clinics clinical guidelines, quality and clinical data malpractice and attorneys role of the individual in their own healthcare universal healthcare private/ public health insurance

Physicians Around the World Discuss Healthcare Issues

As a nation we are on the threshold of the next evolution of our present healthcare system. This generation will either be remembered for creating a great healthcare system or creating a financial/healthcare disaster. While Congress and the President try to craft, hopefully, a better system I am going to invite comments/thoughts from physicians around the world. These physicians will be from Canada, the United Kingdom (nationalized healthcare systems in developed countries), a physician who has practiced in the Caribbean and a physician from Nigeria (healthcare in two third world countries). The first hand experiences and thoughts of all of these physicians would create for a lively discussion on comparing healthcare systems not only in United States but around the world.

The three major issues with healthcare anywhere in the world are centered on:

• Quality
  Best outcomes from Best practices
  Continuous process of monitoring, goal setting and improvement
  Includes everyone and every process in the delivery of healthcare
• Access
  Based upon having the appropriate number of healthcare providers within a specified geographic radius
  Being able to utilize these services when needed – available appointments when required
• Affordability
  Ability to pay for healthcare services

Over the following weeks we will discuss:

• private insurance and the role of private insurers in government programs
• the government’s role in providing healthcare including government sponsored insurances e.g. Medicaid, Medicare, Veterans Health Administration
• hospitals, emergency departments and hospitalists
• physician practices, medical homes, urgent cares, minute clinics
• clinical guidelines, quality and clinical data
• malpractice and attorneys
• role of the individual in their own healthcare
• universal healthcare

Please feel free to share your thoughts, comments, disagreements with this group of doctors….