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Last Updated: Feb 13, 2017 - 1:45:37 AM |
The Bahamas Insurance Association (BIA) has reviewed the Minister of Health’s contribution to the budget debate and notes with dismay the content of his presentation.
We are disappointed that the minister’s communication reiterates the status quo and does not reflect the collaboration with the private sector promised by the prime minister in his recent budget address.
We wish to put on record that Health Minister Perry Gomez is totally disingenuous in suggesting there has been "real consultation" with the private sector. The BIA has addressed this issue on prior occasions and will not restate the obvious - based on the prime minister’s recent undertaking to rectify the issue.
The much anticipated presentation by Dr Gomez was more of the “same old”, and lacked any new information aimed at addressing the anxiety of key stakeholders regarding the proposed National Health Insurance (NHI) programme. His contribution was totally lacking in substance and contained no new specifics.
The speech did little to address the concerns of the BIA, or to remove the uncertainties surrounding NHI. In fact, the speech suggests there is no room for consultation with, or input from, the private sector. His insistence on establishing a public insurer, despite the fact that this make no economic sense and is an unnecessary drain on taxpayer funds, demonstrates a total disregard for the views of the BIA.
Minister Gomez noted that more than $800 million was spent on healthcare in The Bahamas in 2014; half by government and half by the private sector. This supports our position that the projected cost of NHI - as stipulated by the Ministry of Health’s consultants - Sanigest Internationale - may be grossly underestimated.
Our estimate is that the cost of NHI will far exceed Sanigest’s projected costs – by some $365 million at the lowest level to some $655 million at the highest level. The BIA has calculated that the NHI proposal (based on the initial benefits package) would cost between $895 million and $965 million at a minimum.
The minister also said that under the government’s proposal, there would be “no out of pocket costs” or “co-pays” for patients. In our view, this would push costs well over the estimated $1 billion mark, considering the fact that the elimination of out-of-pocket payments will lead to increased use of medical services. The minister also ignored the hidden costs of abuse and corruption that are endemic in the existing Public Hospitals Authority system.
In relation to the amount of money spent on overseas care, the minister seemed to suggest that patients actively sought out medical care overseas even though it could be provided locally. This statement is not factual. Private health insurers always encourage their clients to seek healthcare locally, but there are some conditions for which adequate treatment is unavailable here.
The minister himself admitted that there are many skill sets necessary to providing comprehensive medical care that do not currently exist in The Bahamas. He also said that many doctors, nurses, pharmacists and technicians have to be recruited from abroad to support the local medical establishment.
Under our present system, Bahamians and legal residents can choose to seek medical attention locally or abroad, knowing that their out-of-pocket costs may be higher if they choose the latter. This element of individual choice is essential in a free society. But the minister appears to believe that this fundamental right to choose ought to be eliminated under NHI.
Minister Gomez’s communication indicated that a 'vital benefits package' for NHI has already been developed. This is news to the BIA, as we have had no input or discussion in relation to such development. It is apparent that the minister has either not reviewed the BIA’s position paper or has chosen to completely ignore its content.
The BIA maintains that the government ought to consider the models adopted in other jurisdictions, including the US, which allow individuals to maintain their existing health insurance plans - provided they meet the minimum requirements of a basic benefits package. It also remains unclear what the specific timelines are for the phased implementation of NHI, and what are the key deliverables for each phase.
The private sector and the BIA welcomed the prime minister’s announcement in his budget address that a phased and prudent approach would be adopted to implement NHI. So it is disappointing to note that those charged with the roll-out of this important initiative do not seem to be heeding the prime minister’s commitment to "real consultation with the private sector”. Minister Gomez's contribution to the budget debate did not address any such collaboration.
The BIA notes that classifications and groupings of expenditure items within the 2015/2016 budget have been revised. There have been reallocations, eliminations and consolidation of certain government expenses. In particular, the allocation for the Public Hospitals Authority of approximately $200 million, and an additional $60 million for the strengthening of the public health system, have been consolidated in a new line item labeled “NHI”.
While the total allocation to NHI in the budget is $274 million, it is unclear under which category the health insurance premiums for law enforcement officers, nurses, teachers and other public service employees are captured within the budget. Members of the BIA have been inundated with calls and enquiries from the aforementioned public servants who are concerned that their benefits may have been taken away from them without any notice or consultation.
While the recent press release by the Ministry of Finance addressed this matter to some extent, there are still a number of unanswered questions. Specifically, what will happen to the existing health insurance plans for public servants in 2016? We appeal to the government to bring clarity to this situation and address the concerns of these policyholders.
On a general note, the BIA is concerned that the government is sending mixed signals with the recent statements of the health minister and the consultants he has engaged. Specifically, we are seriously concerned that Sanigest seems to be proceeding with its plan for implementation without any regard for the views and recommendations of the BIA as contained in our position paper. This is in direct contradiction to the prime minister's stated position on the way forward with NHI.
We call on the government to bring some order and structure to the implementation and consultation process in the national interest. It is apparent that there is a lack of coordination between the ministries, agencies and consultants involved with helping us achieve the progressive objective of universal health coverage. This is detrimental to our nation. We must all be on the same page and work together to make universal healthcare a reality in The Bahamas.
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