Americas
Americas
St Lucia
Government moves towards universal health care
Keywords: Health care quality, Health equality, Health care policy
Moves continue in St Lucia towards the inauguration of a new concept designed to make quality health care more readily available to St Lucians at cost prices.
The government of St Lucia, through the National Insurance Corporation (NIC),the Ministry of Health and other health service providers, have been discussing the setting up a Universal Health Care (UHC) programme that will provide residents with equal access to health care, defined in a published package of services and benefits.
UHC will ensure that residents have access to quality health services regardless of their financial status. Health officials lament the current high cost of medical services and the rising number of St Lucians who seek medical treatment without paying for them. According to administrator of the Vieux-Fort based St Jude Hospital, Mr Paul Meroe, in most cases, government has to foot the bill.
The present situation, Meroe says, cannot continue. “The introduction of UHC is a beautiful development for VH as well as for St Jude.” According to the administrator, who has severed at Golden Hope Hospital, Turning Point and Victoria Hospital, “the volume of exemptions that we have and the very fact that UHC will be covering everybody, those institutions stand a chance of recovering almost 100 per cent of the services that are not being paid for at this point in time.”
The new system will be funded with a fixed tax on consumption goods. That proposed flat tax is a 3.5-4 per cent increase to the environmental levy, which now stands at 1-1.5 per cent. The name will be changed to Health and Environmental Levy and will now be charged at 5 per cent. Basic goods such as food and clothing have been exempted. The tax will raise an estimated 30 million dollars, with government matching that amount as part of its overall contribution to health care.
Proponents of the concept say it’s not perfect but it will level the playing field and greatly improve the ability of service providers like Victoria Hospital and St Jude to provide quality care.
“Right now there are serious problems in the health services, serious problems link to quality, financing, poor coordination, inequity,ineffectiveness and inefficiencies,” says Chief Medical Officer Dr Stephen King. In his words, “the healthy sector was built on three pillars,efficiency, effectiveness and equity. UHC is an ideal mechanism to achieve those objectives.”
UHC is still several months in the making as stakeholders work on fine-tuning the system. It will cover several broad headings like services offered, overall coverage, overseas treatment, establish criteria for persons to qualify under the new system, redress, and will be flexible enough to allow persons wishing to keep their own private medical insurance to do so.
For more information, see www.caribbeannetnews.com
100 years of progress in tuberculosis treatment
Keywords: Public health care, Clinical trials, Disease management
Over the past century, the use of anti-tuberculosis drugs has changed tuberculosis from a disease with a 50 percent mortality rate, which was treated by collapsing the affected lung and rest in a sanatorium, to a condition successfully cured by use of chemotherapy.
The initial key step in the development of modern chemotherapy for tuberculosis was the demonstration in clinical trials, starting in 1946, that the antibiotic streptomycin might be a viable drug for the disease.
The results of early British trials showed a substantial benefit to the streptomycin arm of the trial. However, soon many patients developed antibiotic-resistant strains and little ultimate benefit came to those treated. The next big movement forward came with the introduction of a combination of drugs, including streptomycin, to prevent the emergence of drug-resistant Mycobacterium tuberculosis.
By 1955, clinical trials in Great Britain showed that almost all tuberculosis strains had primary resistance to only one drug. Treatment with a two- to three-month three-drug phase, followed by two drugs, became the world standard. Yet patients had to take the regimen for 12 months.
In 1956, researchers in Madras, India, found that results from those who were treated with tuberculosis drugs at home compared equally well with those treated at a sanatorium.
Furthermore, they discovered that family members who were in contact with the tuberculosis case daily were no more liable to develop the disease than were relatives of those who were treated at a sanatorium.
Then, using a drug called pyrazinamide discovered in 1952, US researchers working with experimental tuberculosis in mice showed that as bacterial metabolism slowed down from the action of other drugs, pyrazinamide worked with more bactericidal effect. Out of the multiplicity of random clinical trials that were carried out over the years, two drug regimens emerged as treatments of choice.
The first was a six-month regimen in which rifampin (a potent sterilizing agent) was given throughout the time period. Patients began treatment with two months of streptomycin, isoniazid, and pyrazinamide, followed by four months of isoniazid, and, as stated, rifampin. (Streptomycin has been replaced with ethambutol in many settings.) The second treatment choice was an eight-month regimen of a combination of these drugs, which a recent randomized clinical trial has shown to be “distinctly inferior to the six-month regimen with rifampin throughout.”
The article about the remarkable history of tuberculosis treatment appears in the first issue for April 2005 of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.
American Thoracic Society Journal news tips for April 2005 (first issue)
For the complete text of these articles, please see the American Thoracic Society Online web site at www.atsjournals.org
