Protecting the poor and the medically indigent under health insurance : a case study of Jamaica

This study provides guidelines to the implementers of the NHIP. The present study: (1) identifies the illness patterns and expenditure profiles of the patients with three main chronic illnesses -- cancer, diabetes, and mental illness; (2) uses the data to estimate the cost of treating and covering these diseases; (3) examines the level of medical indigence or at risk-of-medical indigence experienced by the persons surveyed; and (4) examines the factors associated with medical indigence or at- risk-of-medical indigence. One hundred patients suffering from each disease were interviewed using a structured questionnaire. Cancer incurred the highest mean cost to patients, followed by diabetes and mental illness in that order. Approximately 60% of the patients revealed that they were having financial difficulties. About 21% of the sample have foregone health care because of financial difficulties. The study showed that medical indigence is a more dynamic process than is envisioned by the Ministry of Health (MOH). Medical indigence occurs when one cannot treat one"s illness because of financial difficulties that may have existed prior to the illness or that may have begun after its onset. The study indicated that the category "medically indigent" includes more than the official poor. In fact, persons who are working can find themselves in medical indigence once they are forced to pay the high costs associated with their chronic illnesses. These persons are more at risk because the health services will demand more from them. The patients used several means to cope with the difficulties facing them because of their illnesses. There was a heavy dependence on family in time of financial distress. The second important coping strategy was "hoping for improvement". Other strategies included "budgeting" or "borrowing" to meet their needs. Includes policy recommendations. (Author abstract, modified)