Federated States of Micronesia Health Services in Relation to Medical Services (Working Paper) [2002] JSPL 4; (2002) 6 Journal of South Pacific Law

Federated States of Micronesia Health Services in Relation to Medical Services

By Johnson Asher, LLB

Introduction

The Federated States of Micronesia (FSM) is a small country with an approximate population of 100,000 people. A great deal of the population relies on a public health care system that is controlled and regulated by the state governments (Yap, Pohnpei, Chuuk & Kosrae). The present health care system in the FSM has three levels: the community dispensaries, the state hospitals, and referral to hospitals outside FSM. [i] The referral program reflects the shortfall of medical doctors and equipment, which has caused the FSM people to rely heavily on their respective state governments for free health services. Because, many people believe that the law confers an individual right to health care, the misconception that the state governments bears the duty to finance tertiary health care is overwhelming. [ii] This belief may have stemmed from an adaptation of the Trust Territory administration, during which US was responsible for the cost of all medical referrals treated at the naval hospitals in Hawaii. [iii] Currently, the government denounces the assertion that there is a “right to health care” and because of such right the public hospitals have a duty to finance treatment of medical referrals.

Today, there are many FSM citizens that are still confused about the role of the government in relation to tertiary health services. Complaints and disgruntled spirit of the public is seemingly increasing and possibly may lead to a controversial legal bout between the public and the government. It is therefore imperative that the FSM people be informed of their medical referral programs specifically whether the law compels public or state hospitals to pay for the medical treatment of referral patients. The task of this paper is therefore to inform the people of FSM precisely what the law is in relation to financing of tertiary health and the significance of why the law is the way it is today. Thus the question that arises is whether or not there is a “right to health” in FSM and from such right whether there is a duty by the state governments to finance offshore medical referral treatment?

Scope of this Paper

To foster a comprehensive understanding of the task of this paper, and simultaneously facilitating a simple and coherent answer to the main issue of this paper, the substance of the paper will be outlined in the following manner: first it will give a brief history of FSM and the commencement of the referral programs to illustrate the factual background of the controversy between the people and the government. Then, in trying to answer the issue above, the paper will identify and examine the relevant FSM laws. From a thorough scrutiny, the paper will first unravel the legal position between national and state laws to determine; 1) whether or not there is a right to health care in FSM? 2) Whether the state hospitals have a duty to provide health care to medical patients? Subsequently, the paper will determine whether such duty is extended to free tertiary health care or services. Next, the paper will identify the often popular justifications for imposing or establishing a duty for the government to pay for offshore medical referral treatment. These justifications will be discussed and critically analyzed to determine whether they are legitimate. The paper will also highlight practical legal constraints and local factors that hamper the notion that the law should be changed to confer a right to health care. Finally the paper will conclude by explaining why the law is the way it is and how it fits the current circumstances of the FSM and serves the interest of the FSM people. The paper will focus mainly on the state of Pohnpei and Kosrae.

Shaping of a Nation

A little history of FSM is necessary to appreciate the instigation of its medical referral system and why it is a controversy today. The Federated States of Micronesia (FSM) is one of four distinct political entities to arise out of the United States administered Trust Territory of the Pacific Island (TTPI). [iv] The TTPI was supervised by the United States, through its department of Interior, under the United Nations Trusteeship system. The TTPI was the last remaining of the trusteeship established by the United Nation after World War II. After over a century of foreign domination-successively under Spanish, Germans, Japanese, and Americans [v] -the people of Micronesia finally gained political independence on November 3, 1986, as a new nation in the international community. [vi]

FSM is composed of four states, named after their main islands, and dozens of atolls extending over a large area of the north central Pacific. The four states are: Pohnpei (formerly Ponape), Kosrae (formerly Kusaie), Chuuk (formerly Truk) and Yap. The federal capital is located at Palikir, on the island of Pohnpei and close to its largest city, Kolonia. The FSM is a constitutional democracy, and it is party to a Compact of Free Association with the United States. Each respective State has its own government and runs its own state hospital.

Beginning of a Medical Referral System

According to the Administrator of Kosrae Health Services, the history of the present health care system has its roots in the early US naval administration after World War II. [vii] Although Public health services actually started earlier during the reign of the Japanese administration, it was not until the US takeover where health development starts taking shape in the Pacific Islands. Health development was in a sluggish pace at first. The first signs of development were seen in the improvement of the human resources and the participation of the local people in health programs. For instance, the first crop of Micronesian medical trainees was sponsored by the US Navy to train as medical and nurse assistants in Guam. [viii] But during those early years, there were no hospitals and no medical referral system.

A radical changed occurred during the early 1960s when US became intolerant with the United Nations’ continuous reports that progress in the Trust Territory was slow. [ix] Slim budgets were augmented to several times what they had been. The US after assuming the responsibilities to provide basic health care that was once the local communities’ had started constructing new dispensaries. [x] Responsibility shifted from the community to US government for providing local health care. [xi] The US government paid all the bills; it hired and supervised the local medics, while the community, relieved of this burden, could stand by and watch. The US government built hospitals on a larger and more modern scale. After all that development, US realized that the Micronesian people were still substantially deprived of proper medical diagnosis and treatment. In light of this predicament US initiated a Pacific Island Health Care Program where patients were sent to Tripler Army Medical Center in Hawaii for appropriate medical care and services. [xii]