NASSAU, Bahamas - While it is unclear when the draft National Health Insurance (NHI) Bill will be tabled in Parliament, the Bahamas Insurance Association (BIA) is voicing concerns about certain key provisions of the draft legislation. Specifically, the BIA says the draft Bill awards expansive powers to the Minister with responsibility for NHI without adequate mechanisms for check and balance. The Bill is also silent on who the Minister responsible will be – whether NHI will be a distinct portfolio or if this significant scheme will be added to the portfolio of an existing ministry or minister.
Citing as examples Clause 9 of the Bill, in which the Minister is empowered to “give to the [National Health Insurance] Authority such directions of a general or specific character regarding the discharge of the functions of the Authority”, and Clause 4 (5), which gives the Minister unfettered rights to amend the constitution and procedures of the Board, Tina Cambridge, a former Chairperson of the BIA and member of the BIA NHI Committee, said the Bill “creates significant opportunity for political interference, removing the autonomy, independence and objectivity in the running of the NHI Authority, and reduces Board members to agents of the Minister, who then becomes a law unto himself.”
Clause 8 (1) leaves to the Minister (instead of the Board) the responsibility to hire or terminate key personnel, including the Authority’s Legal Officer and Medical Officer, while Clause 43 (1) (e), Cambridge said, appears to allow the Minister, without the consent of parliament, to make regulations, including a regulation to dictate which categories of persons would be exempt from NHI contributions, co-payments or other cost-sharing obligations of the plan. She expressed the significant potential for abuse, noting that the proposed law gives too much power to the Minister to change regulations arbitrarily without involving the legislature. “Changing who pays contribution or co-payments could have material financial implications and the Minister should not have the unilateral ability to do this,” said Cambridge.
The Bill also purportedly goes against corporate governance best practices in identifying the composition of the Board, which, according to the proposed Board Constitution, is currently proposed to include 12 persons, “seven of whom shall be appointed by the Minister from among those categories of persons that would be regarded as representative of the views of the beneficiaries, the medical and nursing profession, and the religious, commercial and labour sectors.” According to Lyrone Burrows, Deputy Chairman of the BIA, the insurance industry is “notably absent” from this list. Burrows added that the proposed corporate structure is “highly deficient and opens the flood gates for political interference, cronyism, nepotism, conflicts of interest and political patronage.” The ex-officio non-voting members, which are proposed to include the directors of the NHI Authority, National Insurance Board and Social Services, plus the Superintendent of the Insurance Commission and the Chief Medical Officer, are civil servants/government employees which, Burrows surmised, gives the Minister too much power over the governance of the NHI Authority and composition of the Board.
The BIA met with the NHI Secretariat on Monday, March 14, 2016 at which time the groups discussed the draft NHI Bill and preliminary observations. The BIA expects to provide its formal feedback including comments and proposed amendments or recommendations to the NHI Secretariat on or before April 15, 2016.
