Health reform refers to changes in health administration, health planning, and health research that place significant emphasis on local health challenges aimed at improving health administration, health planning, health and medical care. They will be combined to produce an efficient healthcare delivery model capable of increasing the physical, medical and psychological safety of the patient. Health reform must be driven by evidence, best practices, and evidence-based practices. A variety of health statistics; such as mortality, labor needs, technology performance, and patient satisfaction; they should be analyzed and used in strengthening health systems.
In Trinidad and Tobago, the current health care system is highly centralized. The Ministry of Health maintains operational supervision of five regional health authorities. These are the North West Regional, the North Central Regional, the Eastern Regional, the South West Regional and the Tobago Regional. Southwest, Northwest, and North Central are the largest regions; each catering for health care needs more than three hundred thousand people.
A significant reform should be the specialization of the Ministry of Health in fewer functions aimed at improving the efficiency of medical care. For example, you can focus on data collection and analysis. It must have expert health researchers responsible for analyzing changes in epidemiology and trends in morbidity and mortality. In addition, the Ministry of Health should have the power to instruct regional authorities to make systemic and resource changes based on the statistics collected and analyzed. Regional bodies should be mandated to provide health-based statistics to the Ministry of Health on a quarterly basis. The Ministry of Health must maintain the general supervision of the regional authorities. You must produce annual reports based on self-monitoring and evaluation of the systems, performances and challenges in each region. Financial statements and audits must be presented annually to the Ministry of Health and the factors that explain the variation must be justified. Recommendations should be made for improvements and incidences of white collar crime prosecuted.
An important reform that must be implemented is to grant absolute autonomy to the regional health authorities for the provision of medical care. They should be able to generate their own funds by charging fees for their services. This would eliminate reliance on the state or Ministry of Finance for funding. Each regional health authority should be able to invest in the stock market or undertake other income-generating measures that it deems feasible. Its funds must be spent in accordance with the health needs of the population it serves. Regional authorities should be responsible for primary, secondary and tertiary health care. In addition, they should be given oversight of private hospitals and health facilities in their geographic regions. Private facilities must be subject to price controls to avoid exorbitant charges and must pay at least ten percent of their annual profits to the regional authority.
In addition, regional authorities must have the power to ensure that all health institutions and providers adhere to national accreditation standards. The Ministry of Health should have the responsibility to develop national accreditation standards in all aspects of the operations of health institutions. These should include hospitals, pharmacies, private practice. Also conventional and alternative medicines must be subject to accreditation standards. Each and every health-based institution should be subject to accreditation standards comparable to those of more developed countries such as Canada and the United States.
It is palpable that the limits of each regional authority are redefined so that they have an almost equal population size. Right now, South West Regional is responsible for just over half a million people. Therefore, given its limited resources, it cannot be expected to function as efficiently as possible. Given that the best health facilities are located in urban centers, this would be a challenge that must be overcome with prudence. To accommodate this reform, regional authorities should induce joint public-private partnerships in the provision of health care centers in rural districts and others less accessible to major hospitals and health centers.
For the health system to be efficient, a centralized electronic health record system must be developed and implemented. This would ensure that patients could access care in any region. Therefore, it would facilitate access to the health records of any health center that is owned and managed by any regional authority. The Ministry of Health is expected to take a leading role in this undertaking. Patient records in private hospitals should be accessible to regional authorities as they may be transferred to a public hospital if the care they require cannot be obtained there. Sometimes, for financial reasons, such as exorbitant cost, patients may be transferred to a public hospital.
Employment policies should allow the free movement of skills and knowledge between regions. In some cases, highly specialized surgeons and caregivers must be available to patients in other regions as needed. In other words, one region can pay another for the services of its demanded qualified human or physical resources.
Regional bodies can collaborate in health planning. They can develop their strategic, business and budget plans cooperatively. Later, they can modify their plans to fit the needs of their population. The main advantages of central planning will be greater transparency, accountability and interoperable functionality. Interplanning can reduce competition between regions and ensure that scarce resources are used efficiently. In effect, the Ministry of Health can compare operational effectiveness and best practices across regions and provide opportunities for operational strength or institutional efficiency.
The health system must be reformed so that it can provide high-quality care to patients. Patients must be well educated to take advantage of a competent, highly organized, and skillfully managed health care system. Finally, the reform must involve all stakeholders; government, private doctors and citizens. A converging bottom-up and top-down model must be adopted so that there is universal acceptance of health reform capable of contributing to the economic and social development of the country’s human capital.
