Health sector reform is a ‘significant and intentional effort to improve the performance of the health care system’ (Roberts, Hsiao, Berman & Reich, 2004).
The authors use the term depending on what they propose defines a health care system, which includes immediate performance results (efficiency, quality, and accessibility) and performance goals (health status of population, citizens’ satisfaction, protection against financial risk).
Health sector reform in Jamaica started in the 1970s. There are many elements of health sector reform, however, this paper focuses on decentralization and cost recovery as two (2) elements of health sector reform in Jamaica along with one (1) advantage and disadvantage on the nursing profession.
In many developing countries decentralization is a significant component of health care reform. Decentralization is an emerging theme within the health sector which began in 1996 with the creation of Regional Health Authorities. It is suggested by many advocates that providing greater authority to local decision-making bodies can improve both the technical and allocative efficiency with which health care systems operate. The island of Jamaica has undertaken the process of decentralizing the administration of healthcare as a part of nationwide structural reform.
The extent to which technical health expertise is involved in the design and planning stage of the decentralization process varies in many countries and often impacts staff equity, worker motivation and performance (Kolehmainen, 2004).
Managers are charged with the responsibility of ensuring that the employees have the necessary resources and tools to do their job and should be able to motivate staff, as well as employing suitable personnel which will impact positively on performance and productivity. In poor resource settings where there are limitations it would require innovations and sometimes sacrifices for managers to achieve these objectives.
Though decentralization seems like the way to go, like many other solutions there are side-effects. The subject of training cannot be over emphasized and it sometimes require more time than the regional health system can afford. This often causes managers to be burdened with the task of importing resource persons for training and development because they cannot afford to compromise the strength of an already under staffed system.
In summary, decentralization (a) Creates major challenges for health service provision. (b) Demands active involvement of health managers in the decentralization design. (c) Helps to ensure clear national resource allocation standards and health service norms. (d) Requires an ongoing system for monitoring which is essential for guarding equity and quality and for improving efficiency. (e) Allow nurses to become more skilled in their tasks.
According to Lowe, Payne, Beckstrom, Duke (2001) cost recovery refers primarily to the collection of fees from persons utilizing healthcare delivery services. At present, cost recovery is reduced primarily to the secondary and tertiary health systems. The government aids in the financing of the health sector. It includes allocation of budgeted expenditure less the amount projected through the cost recovery program. The funds collected through the cost recovery program are used to purchase equipment and varying machinery.
As we look at cost recovery on a positive note nurses are often handicapped in the delivery of healthcare services most times because of the lack of resources which prevents them from having the proper tools and drugs to do their job. With the implementation of the cost recovery where the healthcare purchases the necessary equipment and machinery, the nurses will be able to treat patients more effectively thus resulting in increased efficiency and productivity.
Although cost recovery has many positive effects on the healthcare system, there are negative effects as well. There are many persons who require treatment and demand quality service but will prefer to utilize private health care services once payment is required. This will impact negatively on the demand for nurses. Since persons realize that the cost at the private healthcare service is higher than that of the public healthcare services, this result in them returning to the public health care services for treatment.
In conclusion, although, through personal preferences persons might choose private over public health care, because of the cost, the element of cost recovery aids the healthcare systems in various ways including the provision of the necessary machinery to treat patients efficiently.