The Jamaican Healthcare System: How to Get Care as a French National

The Ministry of Health and Wellness sets policy, steers and regulates the system. Since the 1997 National Health Services Act, four regional health authorities directly manage the public networks: South East (SERHA), Southern (SRHA), Western (WRHA) and North East (NERHA). According to the Jamaica Information Service, the ministry operates 23 public hospitals, including the semi-public University Hospital of the West Indies, to which are added 6 specialist hospitals (maternity, children, cancer, rehabilitation, mental health, respiratory diseases) and about 350 health centres.

Public hospitals fall into three types according to the services they provide: type A, with the Kingston Public Hospital and the Cornwall Regional Hospital as examples, offers reference secondary and tertiary care; type B, in the larger towns, provides general surgery, internal medicine, obstetrics and paediatrics; type C, the district hospital, provides general medicine, basic surgery, maternity and simple radiology. There is at least one hospital per parish. The system relies on primary care: health centres assess the patient, then refer them to the next level.

User fees were abolished in public facilities from 1 April 2008, an announcement made by the Governor-General in the Throne Speech of 27 March 2008 (Jamaica Information Service). Free care applies, in all public facilities except the University Hospital of the West Indies, to registration, medical consultation, surgery, medicines, diagnostic tests, haematology, maternal and child health (including family planning), ambulance service, physiotherapy, transfusions and laboratory tests.

The JIS article does not specify any condition of nationality or residence: it is up to a foreign patient to confirm with the facility the conditions that apply to their status and the procedures that are still charged. Waiting times and the level of equipment vary from one facility to another, which explains the frequent use of the private sector for scheduled care.

The private sector includes hospitals, practices and laboratories in Kingston, Montego Bay and the tourist resorts (the JIS counts about ten private hospitals). It is paid: care is settled on the spot or through insurance that offers direct payment. The names and fees of private facilities are not repeated here; always ask for a written quote, and confirm with your insurer the facilities in its network (see direct payment).

The National Health Fund (NHF), a statutory body created in 2003 by an act of the same name and placed under the ministry’s control, aims to improve access to medicines and care. Its card gives access to subsidised medicines in the public and private sectors; a list of subsidised products can be consulted on its website. It is not a health insurance scheme: it covers neither consultations, nor hospitalisation, nor surgery.

The first point of contact is a public health centre or a private town doctor. For an emergency, France Diplomatie does not publish a list of numbers or hospitals: the safest course is to note, on arrival, the local numbers in force and those of the French embassy in Kingston (+1 876 619 7812 during office hours, +1 876 843 32 35 outside office hours). A JIS article gives 110 for fire and ambulance emergencies; these numbers may change and should be confirmed with the local authorities.

• Prescriptions: France Diplomatie advises taking only the strictly necessary medicines in their original packaging, with a prescription written under the international non-proprietary name, and checking that they are allowed in Jamaica.
• Purchases: never buy medicines from street vendors.
• Dentist: a dental check-up before departure is recommended by France Diplomatie.

For a serious condition requiring evacuation, the insurance contract must guarantee medical evacuation and medical repatriation.

France Diplomatie flags the following points:

• Mosquitoes: transmission of dengue and chikungunya is confirmed in Jamaica. Dengue has no curative treatment and anti-inflammatory drugs should be avoided; zika can have serious consequences for the unborn child, and women who are pregnant or planning a pregnancy see a doctor before travelling. Protection relies on covering clothing, repellents, mosquito nets or air conditioning and the removal of standing water.
• Ackee: this national fruit can cause serious, sometimes fatal poisoning if picked before it is ripe; France Diplomatie advises eating it only in a restaurant.
• Water and food: typhoid fever is transmitted through contaminated water or food; drink bottled or treated water, cook food thoroughly and wash fruit and vegetables.
• HIV: the country page mentions a significant prevalence.
• Vaccines: French schedule up to date (diphtheria, tetanus, polio, whooping cough, measles). Yellow fever is compulsory for travellers coming from endemic areas; hepatitis A and B and typhoid fever are discussed depending on the length and conditions of the stay; chikungunya and dengue may justify vaccination depending on the situation.

A consultation with your regular doctor or at an international vaccination centre several weeks before departure makes it possible to tailor the programme.

An employee registered by their employer is affiliated to the National Insurance Scheme, a social security scheme that does not replace health insurance. For other profiles, access to the public sector is confirmed on site; access to the private sector is paid for or insured. No social security agreement exists between France and Jamaica (CLEISS): French social security does not reimburse routine care received in Jamaica by a person who lives there, except where cover is maintained under a secondment. The options are detailed in the guide to healthcare reimbursement in Jamaica, the page on healthcare systems around the world and the Jamaica country page.

In a country regularly hit by hurricanes, it is prudent to check that the insurance provides for evacuation and to keep an up-to-date list of the facilities accessible from where you live.

The profile of the Pan American Health Organization (PAHO) indicates public health expenditure of around 5% of GDP and household out-of-pocket payments of about 13% of total health expenditure. Life expectancy at birth is over 71 years. The “Vision for Health 2030” plan aims at universal access to care, with the extension of primary care, the modernisation of infrastructure and the strengthening of the Ministry of Health’s governance.

A woman who is pregnant or planning a pregnancy sees a doctor before travelling, as zika can cause serious neurological complications in the unborn child; protection against bites and against sexual transmission is essential. Maternal and child health, including family planning, is among the public services with no user fees since 2008 (excluding the UHWI).

For long-term treatment, take the prescription written under the international non-proprietary name and check that the medicines are authorised in the country; the National Health Fund card helps finance a list of medicines in the public and private sectors. For children, an up-to-date French vaccination schedule, protection against mosquitoes and vigilance about unprepared ackee matter.