When it comes to health, Trinidad and Tobago truly is at the crossroads of North and South America. While its third-highest GDP per capita in the Americas, and therefore potential health spending, would put it on par with the United States and Canada, its actual health statistics reflect that of a more Latin American country. Infant mortality, communicable disease rates and life expectancy have all improved over the past 20 years, though they have not improved as much as other regional countries, especially odd considering the twin-island republic’s 2011 improvement to developed country status.
However, as expected with other developed countries, one of the main reasons Trinidad and Tobago has a life expectancy of only 70 years is due to obesity brought on by local food consumption habits. These include not only high salt content and fried foods, but also cultural acceptance of over indulgence in both food and alcohol. In a July 2017 assessment of the Caribbean region, the UN’s World Health Organization in conjunction with CARICOM and the Pan American Health Organization said that 40 percent of non-communicable diseases (NCDs) are “premature” and “potentially preventable.” These NCDs are typically cancer, diabetes, heart attacks and strokes, a majority of which are exacerbated by obesity and its concurrent risk factors of high blood pressure and high blood glucose.
Primed to deal with this “developed world problem” is a two-tiered healthcare system, with both private and public facilities. The latter is a government-run system offering primary, secondary and tertiary level care under the direction of the Ministry of Health (MoH). This public network can be accessed through nine hospitals, 97 health centres and nine district health facilities, while administration is handled through the country’s five Regional Health Authorities (RHAs).
While the public health system has had its problems - a lack of hospital beds and local medical labour - it has also made significant progress in the realms of infant immunisation, infant mortality and communicable disease prevention over the past five years, all of which were made more important by the 2015-16 outbreak of the Zika virus within the region.
In late 2015, the government announced they would make the Universal Health Insurance Programme a priority, which would provide Trinbagonians access to the health care tier of their choice by December 31, 2018. However, the new insurance plan on top of the two-tiered health care system still needs private partnerships to settle costs, quality assurance and standard care practices.
For the government’s part, there still needs to be a set plan on how the programme will be financed in the years to follow, along with funding for other existing public health care policies such as the National Health Card (rolled out in September 2015) to further subsidise public access to health care services and prescriptions. Realising these goals will be a tough hill to climb as health care funding - now the third largest item in the 2017 national budget at 6.25 billion TTD - will have to contend with the oil and gas industry’s prolonged slump. Consisting of 40 percent of the country’s GDP, petroleum revenue has fallen by 92 percent from 2014 to 2016, according to the Ministry of Finance’s 2017 Budget Statement.
However, the private insurance market could make up for any government revenue shortfalls to cover for these ambitious programmes as the sector has been able to deal with low interest rates for a decade and still achieve growth, often in excess of 10 percent return on equity. The current market leader in the private insurance sector is Guardian Holdings at 60 percent market share in life and pensions, and 30 percent in non-life and property & casualty insurance, followed by Sagicor Life and five other composite insurance companies.
For any progress to be made on this front though, a comprehensive reform of insurance regulations needs to take place, as the last overhaul was in 1980 and subsequent reforms have been promised in 2002, 2015 and the present year to no avail.
As opposed to the government revenue-dependent public health sector, the private sphere has not been affected nearly as much by falling global hydrocarbon prices. Overall growth has been nearly flat during the recession, but specialised services such as dialysis and radiology have posted gains over the past couple of years.
With a 39,000-patient capacity and 10 medical institutions, the private health sector has seen increased demand overflow from the constrained public sector. So much so that one of the primary reasons dialysis services have seen growth in the sector is due to public health care tier subcontracting under the External Patient Programme. As costs will have to be controlled within the public sector in the current fiscal environment, more and more high-cost, specialised services such as cancer treatment will be subcontracted out to the private sector, leaving the public sphere to focus on generalised basic treatment.
While private health insurance coverage is still low compared to the rest of the developed world, its adoption in the local market has risen considerably in the past 20 years. Formulating clear, strong and modern regulations not just for the private insurance sector, but also for the private health care tier, would encourage more market competition and allow more consumer choices as to how they access the dual-tier system.