Page 37 - GHES-2-3

Global Health Economics and
Sustainability
Innovating sustainable specialized healthcare

to bridge the large and growing gap in fiscal resources that individuals to participate in funding state projects such as
specialized healthcare increasingly demands. specialized health-care. However, Jamaica’s tax efficiency
Ultimately, this fine balance in the way scarce funding has also been improving over the years, as has been noted
is spent includes the increasingly recognized social-health in many other middle-income countries in the process
divide (Papanicolas et al., 2019). While it was previously of development (Ortiz-Ospina & Roser, 2016). The tax
thought that social spending reduces the need for health efficiency is now approximately 23.5% of GDP, comparing
spending, the relationship appears more positive in high- favorably to the world average (19.3%) and higher than the
income countries, where more social spending is associated levels collected in the countries of the Latin American and
with more health spending at a national level. Therefore, Caribbean Region (18.4%), the LMICs (18.3%), and other
more health-care funding will still need to be found as Caribbean Community countries (19.3%) (Arturo Jacobs
expectations increase and specialization becomes necessary. et al., 2012). Despite this growing efficiency, the cost of
specialized healthcare would still be a disproportionately
7. Proposed practical strategies large burden on the available revenues from taxation.
In the US, an interesting recent development is the model Third, a national insurance health scheme similar to
of a public benefits corporation (PBC). A PBC is a for-profit what South Africa is implementing may be an effective way
corporation that produces one or more public benefits and of addressing the inequalities in health-care affordability
operates in a sustainable manner. It typically focuses on that presently prevail, increasing access to better
artistic, cultural, economic, educational, environmental, healthcare for those who cannot afford it. This subject has
literary, medical, religious, or scientific activities. The for- been discussed in the local media but has not gained the
profit purpose implies that the corporation will be run with necessary traction for advancement (Linton, 2019). It is
the rigor expected of any other for-profit corporation and hoped that the South African model will prove successful
will have the same requirements and expectations from and catalyze a similar initiative in Jamaica and other small
their shareholders: an enhanced level of accountability and island economies. While not a mechanism to increase
transparency compared to a non-profit organization, which inflows of new funding sources, it enables broad-based
adds to its overall appeal (Wong, 2023). Consequently, it is societal contributions to develop ways of paying for and
more attractive as an investment opportunity. Developing therefore offsetting, the final cost of specialized healthcare.
the legal framework for a similar structure in Jamaica may These innovations will require government buy-in for the
make investing in specialized health-care more attractive creation of relevant policies to allow their development. In
to Jamaican entrepreneurs. These individuals may be individual countries, it will require access to decision-makers,
interested in engaging in the health-care space but lack relationship-building, and the assembly of key stakeholders
prior experience and may prefer sustained engagement to achieve the critical mass and momentum necessary to
over charitable or non-profit formats, which have less see these major innovations through. Finding an influential
accountability than they are accustomed to. champion to take this on will likely be the first critical step in
In line with this, a practical contribution could be the this journey. A potential additional benefit is that an improved
formation of a Jamaican Philanthropic Society for Health. specialized healthcare infrastructure could result in a lucrative
A relevant concept in this discussion is that of normative medical tourism industry. Clients from North America could
organizations, developed by Etzioni (1975). Normative access high-quality care geographically close to home instead
organizations, also called voluntary organizations, allow of making long trips to Asia for care that is either unaffordable
people to pursue their moral goals and commitments. (as in the US) or subject to long waiting lists (as in Canada)
Members are not paid but instead contribute their time or in their home country (Béland & Zarzeczny, 2018). There is
money because they like or admire what the organization currently growing interest in this space.
does and value the opportunity to be part of its activities. Quality improvements can also greatly help control the cost
The members of such groups inspire and energize each of care. Data should be analyzed, patient-centered goals set,
other, working together to achieve social goals of common checklists used, and standardized protocols created to lessen
interest. Jamaica is already one of the most heavily taxed human error and track progress. As the famous management
countries in the Caribbean and Latin American region, consultant Peter Drucker once said, “If you cannot measure
with a tax-to-GDP ratio of 27.9% compared to the regional it, you cannot manage it.” (Drucker, 2007, p. 40).” This
average of 21.7% (OECD, 2023). Additional taxation would increasingly applies to the complex world of healthcare
be a major disincentive to contributing philanthropically administration. More efficient use of resources can help
and participating in person. This is a reason to consider improve life expectancy even without increased expenditure.
philanthropy as a more satisfying way for high-net-worth Inefficient countries would reap the highest benefits from such

Volume 2 Issue 3 (2024) 9 https://doi.org/10.36922/ghes.2717