The trouble with the Mauritian Health System

In a  WHO report on the overall efficiency of health systems, the Mauritian Health System ranks 84th out of 191. This is pretty dismal for a country with an annual GDP per head of $11 000 (at purchasing power parity). Indeed, Mauritius came behind countries that have GDP per head of $4000. In practical terms, the inefficiency of the health system is reflected in an infant mortality rate still in excess of 10 per 1000 newborns, and in an average life expectancy which is only slightly above 70.  What is wrong with the Mauritian Health System, a system based on the UK’s NHS (meaning that it is universal and free at the point of use, and is funded by taxes)?  The question is certainly worth asking as Mauritius is set to become the country most affected by the H1N1 flu in Africa. The short answer is that Mauritius spends only 4% of its GDP on health and this is too little by any standard (for instance, most OECD countries spend more than 8% of their GDP on health). So why is so little spent on health care as a % of GDP, while in other areas, such as education and even infrastructure, the gap between Mauritius and middle/high income countries is not that wide?

The reasons are a mix of

1. A lack of public support for a strong publicly-provided health care system. Such a lack of support is often the case in highly unequal societies where the middle class prefer to have recourse to the private sector rather that subsidizing a publicly-provided system.

2. Additionally, Mauritian may not fully realise how much better their health system could be in terms of saving, improving and prolonging their lives. In his recent book “The Idea of Justice“, Amartya Sen explains why individuals may not realise how bad their health systems are:

A person reared in a community with a great many diseases and little medical facilities may be inclined to take certain symptoms as ‘normal’ when they are clinically preventable. Like adaptive desires and pleasures, there is also an issue here of adaptation to social circumstances, with rather obscuring consequences.   (page 285)

3. The presence of strong interest groups whose personal interests lies in a public health system that remains weak. As an example, two days ago, the largest private healthcare provider in Asia, the Indian group Apollo opened its first hospital in Mauritius, in a joint-venture with a politically-influential Mauritian group.

To make matters worse, a major weakness of the Mauritian Health System lies in its primary health care provision, which is generally the first point of entry of patients into the health system. Primary health care is indeed largely dominated by private general practitioners, who have an interest that their patients, who are generally ill-informed, stay within their private system. In a country where improvements to the health system are hardly ever debated, not even during election times, and where Health Ministers are hardly ever chosen among the brightest minds, things are not likely to improve soon.