ALMOST DAILY WE HEAR of some complaint relating to services provided at our main hospital. Of course, matters there are not as dismal as one sometimes is led to believe. Every so often we do learn of non-residents complimenting the standard of care provided as well as the level of efficiency of our medical professionals.

In the midst of this and like other countries enjoying a similar stage of development, Barbados has been faced with nursing shortages aggravated by recurring exits of trained personnel in search of greener and more rewarding pastures. And so the question raises its head: What are we doing to stymie the growing appetite of trained nurses for seeking employment elsewhere, primarily because of low wages and in other cases because of the perception that our facilities are not state of the art?

Barbados already spends a substantial portion of its budget on education and health. It is therefore doubtful that there is any room left for further expenditure on its hospital, even though there is a clear need to revitalise and upgrade plant and facilities.

Mention has been made of our potential for the development of health tourism and the establishment of convalescent/retirement homes. While these are desirable they will not, we think, directly impact on the quality of delivery care available on a national basis.

Worldwide, there is a growing consciousness of the rising costs of accessing good medical facilities. So pervasive is this situation that businesses and insurance companies are looking towards outsourcing health care, as a cost-saving mechanism, from the better off countries to parts of the developing world.

For some time now it has been known that the job of X-ray reading has been handed over to India whilst patients from First World countries have been known to visit the Asian countries of Thailand, Singapore and India, originally for cosmetic modifications and upgrading, but more recently for advanced offerings of heart surgery and knee and hip replacements.

What is most disturbing is the fact that health care costs continue to rise at a phenomenal rate to the point where they are now a source of acute stress both to employer and employee. So overwhelming is the problem that some insurance companies providing health protection have been offering policies which allow for procedures to take place offshore in places like Mexico and Bangkok.

We in Barbados can be proud that the range of services available at our main hospital belie the scarcity of funding available, but the question is how much longer will this continue? It is clear that costs will continue to escalate to the point where John Public is likely not to be able to afford such levels of expenditure, and this is the challenge facing our country.

A sure question which will require careful balancing, is the extent to which we should structure our hospital to serve the needs of tourists in search of "inexpensive" health care and use such revenue to offset costs to citizens of Barbados. A thorny matter, but one for serious contemplation.