Since the devastating earthquake on January 12th, hospital services in Haiti have been provided to patients for free. No matter what your status or ability to pay, for three months after the earthquake you could feel certain that you could see a doctor and (hopefully acquire medications) for free. This was a fantastic service and was a great idea because it enabled the poor to have access to the healthcare services that they often go without.
However, the free service in many facilities has now ended because these hospitals have only been guaranteed reimbursement for their services until April 12th. Many hospitals are now struggling with what to do next.
If they begin charging people to see the doctor, the majority of Haitian people will not be able to afford it. Thus, the follow-up treatment that is so essential for people who are newly handicapped and people with chronic conditions will go untreated. However, if they do not charge, many hospitals will be forced to shut their doors. In fact, one of the premier hospitals in the country, Hospital Sacre Coeur (CDTI), recently closed because they sustained a great deal of damage to the hospital building and had to spend so much of their own money treating patients for free while (still) waiting for the reimbursement monies. Like any other business, a hospital must have income to finance their operations. Even the non-profit hospitals, of which there are many fantastic ones in Haiti, have to generate income somehow to pay the staff and the buy the diesel for the generator.
However, there is another devastating aspect of this story. As we all know, there was an incredible number of doctors and nurses who came to Haiti in the aftermath of the quake to assist in these facilities. The work they have done in the past three months has saved countless lives. It has been easy for these medical personnel to work in any of the hospitals and clinics in the area because everyone was providing services for free. These overseas medical personnel don't want to make the patients pay for services they are providing out of the goodness of their hearts. However, now that some hospitals are beginning to charge again, these doctors and nurses are avoiding those facilities that are forced to take fees. These hospitals are now losing the expertise of the overseas medical personnel who do not want to work in a place that is charging the patients for the work they are doing for free.
Unfortunately there is no easy solution to this problem. The healthcare system in Haiti has been set up as a fee-for-service model. To change that now would take a lot of money that Haiti does not currently have. Unfortunately, if it doesn't change, the hospitals will have to begin charging patients, overseas medical personnel will not want to work in these facilities, and the Haitian people will suffer as a result.
An efficient, self-sustaining and self-financing system for health care is very attractive but also very hard to achieve. Even the United States, the richest country in the history of the world, can't quite figure out how to do it. Significant resources have been donated for Haiti in recognition of the immense scale of loss and much of these resources have been used in part to subsidize the most basic goods and services (including health care) that people need but simply do not have the ability to pay for. Pulling this subsidy out now, three months after the worst disaster in the Western Hemisphere seems too abrupt. If there was a gradual lessening, rather than a complete elimination of the subsidy, perhaps there would be time for the market forces to kick in without kicking out all the people who lost everything.