For healthcare, we need more than an ounce of prevention
When it comes to healthcare, Samoa is on two different but equally unsustainable paths.
The first is disease. Much has been written about the growing crisis of non-communicable diseases currently gripping Samoa and the region. As lifestyles grow more sedentary and diets less healthy these kinds of illnesses have surged: the number of Samoans with diabetes jumped from less than 10 per cent to 23 per cent just 15 years.
The second is treatment. Chronic conditions such as diabetes and kidney disease are extremely costly to treat; one year of dialysis treatment alone comes at a cost of $92,000 per patient. And increasingly the hardest-to-treat of these chronic conditions - heart, cancer and kidney ailments - sending patients overseas is the only means of treatment.
But as a story in the Monday edition of this newspaper pointed out (“Spiralling overseas treatment costs needs preventative cure”) the cost of overseas treatments is fast racing away from the Government.
In the 2017-18 Financial Year, the Government spent some $13 million on sending patients overseas, or more than double its predicted budget of $6 million.
To put it another way that represents more than 15 per cent of all Government spending on healthcare.
On its own, the overseas treatment scheme accounts for a greater proportion of government spending than several other entire branches of the Government combined.
It’s plain that things cannot go on like this. Especially not with rates of the most serious non-communicable diseases such as cancer are forecast to rise by 80 per cent in the next two decades, according to estimates published by the Lancet earlier this year. Hypertension, complications from obesity and heart disease do not lag far behind.
The imperatives of treating those in immediate need and keeping the health system sustainable for those who need in future are increasingly in conflict. And it seems likely that we are going to have to make some tough choices.
Previous research by the Ministry of Health has suggested that the average cost to Government of overseas medical exchanges is a tick under $37,000 per patient. The same study shows the number of patients benefiting from the treatment amount to less than 0.1 per cent of the total population.
That ratio again is 15 per cent of our total healthcare outlay being spent on less than 0.1 per cent of our prospective patients.
Research by the World Bank suggests we could be doing more to track how effective this spending really is. Some researchers say sending people overseas for treatments such as kidney stone surgeries and eye cataract surgeries yields mostly good results; but the picture is more complicated for more invasive and complicated treatments.
Obviously noone should suffer when treatment is available. But it’s clear, too, that we’re going to have to make smart choices about the allocation of our scarce health resources while we still can.
The announcement by the Minister of Health Kika Stowers that she intends to revive and enhance the role of Komiti Tumama is a welcome start.
The women’s committees have historically played an important role in giving people in Samoan villages access to disease-based screening and primary health care.
So long as Samoa remains constrained by a relatively small health workforce recourse to foreign treatments is going to be tempting.
After all, building the capacity of our own workforce is easier said than done because of factors such as the brain drain; there are as many Samoan nurses working in New Zealand as here.
But absent a major increase in investment a focus on preventative healthcare seems like the next-best option to addressing the looming public health crisis.
Non-communicable diseases account for up to 75 per cent of all deaths in the Pacific Islands. Many of these are premature and preventable deaths.
For evidence of the contribution lifestyle makes to disease we need look no further than official statistics on diabetes. Rates of this disease are more than three times greater among the wealthiest Samoans than the poorest, according to Government data.
New spending programmes also are not the only option in Governments’ policy quivers when it comes to tackling such diseases: many now use taxation to deter consumers from making unhealthy choices and using the proceeds to fund treatment.
The old cliche has it that an ounce of prevention is better than a pound of cure. We may have been taking these ratios too literally and for too long.
The $13 million we spend on overseas medical treatments many at the most acute stage of medical care, compares to a little more than $1.3 million on preventative health.
It might be time to balance this ledger.