By Rajagopal Soondron
It’s well known to all of us that the duty of our honourable members of parliament is to propose ways to administer efficiently the affairs of the country with a view to ensuring the maximum benefit to citizens of Mauritius. However, the same parliamentarians are ready to implement a shift system for doctors in the public sector — a practice which medical experts generally do not approve of, arguing that it may go against the interest of patients. Yet the greatest concern for citizens remains access to the best health facilities! Nevertheless, we are lucky that our country has maintained the welfare state model of free medical care in the public sector even after Independence.
Sixty years ago, as the majority of us were poor, with only a handful of doctors to manage the health services, we came to rely on that free service to see us through our medical problems. But now with a per capita of about 10000 $, it is was to be expected that educated middle-class Mauritians would think differently and opt for private health care, for the simple reason that the state would find it increasingly difficult to cope with the rising cost of a free health service, especially in the context of a fast ageing population. Generally, private health institutions allow us more privacy and a relatively faster service, given the relatively lower number of patients.
In fact, about 25% of the population use private health institutions, the remaining 75% go to the public sector. But as the health sector is bound to change, with doctors coming face to face with modern concepts of investigations, and the introduction of electronics and genetics into diagnostic/treatment modalities, health care is becoming more expensive and complex. The state will thus have to make tremendous adjustments to be able to continue providing its health facilities. Unfortunately, there is a limit to all free services.
Hence every government of the day has tried hesitatingly to convince the population that there will come a time when they will have to start contributing minimally for their health care. In private, the politicians recognize the soundness of this logic, but they dare not come out publicly about it. It has always been a half-hearted proposition – because no Prime Minister or politician has been willing to date to stake his or her vote bank by asking voters, who have taken free health care as a matter of right, to pay a minimal contribution towards health care. This is why the present government is making timid suggestions that seem more palatable and appealing to civil servants: the setting up of a health insurance scheme, which will hopefully siphon many of those public servants forming part of the 75% towards private health institutions. This is expected to ease the burden on the public service, and improve the quality of care it offers.
In theory, that looks logical and reasonable. But trade unionists are always suspicious of services that go private; surely civil servants will see their take-home pay decreased due to their contributions to a medical insurance scheme. And if the number of patients in the public institutions go down, will not the government be tempted to cut jobs in that sector? Will it go on contributing the same percentage of the GDP to health as is the case presently? Are trade unions powerful enough to influence public policies/policy making? Can they influence the State to go on providing the same or a better standard of public health care, with the same resources to general satisfaction, thereby preventing a two-tier health system in the country – one private and more efficient for the well-to-do, and the public sector’s for the poorer sections?
At the same time the trade unions must see to it that their members in the public sector do not have their rights eroded by a certain practice that is currently in force. Government has allowed foreign doctors, more so specialists in scarcity areas, to be recruited by the private sector. Unfortunately, some institutions are stepping over the line and allowing those specialists to do work which can be managed by Mauritian specialists.
The situation becomes more tricky: specialists in public sector, having spent 10 or more years at the university, cannot draw a monthly wage more than their hierarchical superior – their Senior Chief Executive in the health ministry.
But to be fair the Pay Research Bureau had allowed specialists the right of private practice after normal working hours, to make up for that disparity. However, as the latter discover to their dismay that there are already foreign nationals doing their work in the private sector, the PRB correcting measure becomes ineffective. Would the 75% of the population accept that their doctors in the public sector are frustrated? Such frustration will lead to demotivation and may well impact quality of care. That’s what the trade unionists must look into seriously.
If Mr X has a private health institution, his aim is to do business, far from the ideal of the public health institutions. Mr X would like to employ a foreign specialist, pay him a fixed P sum of money monthly – even when the patients’ insurance companies are paying; but had he employed Mauritian specialists to do the same work he would have had to dish out 5P of insurance money. So instead Mr X, the businessman, will be happy to pocket 4P. So, by employing the foreign doctors Mr X is perpetuating frustration for our own Mauritian specialists – and the poorer section of the population. Mr X would not mind becoming a millionaire at the expense of the poor men’s health.
And matters may become worse as the years go by, because the present old school of Mauritian specialists in the private – more so in the field of anesthesia — will soon have to call it a day. They will be replaced by whom? No one knows. If more foreigners are allowed in to replace them, then we really run the risk of perpetuating more frustration for Mauritian doctors. At the end of the day, they would realize that they would not be able to send their children to the best of universities for studies – as most professionals and other private doctors would be able to do. And the risk of public specialists going private will become real – hereby causing depletion of the public staff — further compounding the situation. The Ministry of Health & Quality of Life must be prepared to help its undergraduates specialize, to parry a weakening of its public specialists force.
And who will suffer? That 75% of the population — from a below par service by unhappy underpaid doctors.
Yet the aim of the State at the very start was always to ensure that the quality of health service in the country remains high, in both private and public sectors, to benefit the maximum of Mauritians, while maintaining frustration as low as possible. Or is the Ministry of Health & Quality of Life willing to pay its specialists a higher wage — corresponding to the 10 or more years that they have put in at university, thereby risking depleting its yearly budget further?
That’s what the trade unionists must fight for, to safeguard their working members’ peace of mind and pay package, and preventing the population attending the public sector from getting a substandard health care.
* Published in print edition on 9 August 2019