A New National Health Insurance - NHI Bill Laid in The Bahamas House of Assembly

The new Bill will lay the foundation for the launch of Catastrophic Care coverage, which is a priority for The Bahamas Government, according to The Minister of Health and Wellness, the Hon. Dr. Michael Darville

The best prescription to address the country’s complex health challenges is an affordable and robust primary health system that can mitigate many of our health challenges brought on by the impacts of poorly managed non-communicable diseases like hypertension, diabetes and cancers undiagnosed in the earlier stages of clinical presentation, said Dr. Darville.

NASSAU, The Bahamas -- The Minister of Health and Wellness the Hon. Dr. Michael Darville laid for the first time in the House on Wednesday,  October 26, a new National Health Insurance (NHI) Bill, 2022, which aims to repeal and replace the existing 2016 legislation that proved instrumental in the initial launch of quality, affordable primary care coverage and services in 2017. 

Dr. Darville explained that the current legislation is no longer sufficient to meet the evolving needs of NHI and the increasingly complex financial landscape presently in the country. 

“Over the past few years, with the ongoing COVID-19 pandemic, we have witnessed first-hand the importance of maintaining accessible primary care and the impacts of primary healthcare coverage on the overall health and well-being of our people. 

“We have also seen the staggering financial impacts of acute care and the tremendous burden at our hospitals brought on by patients suffering from chronic non-communicable diseases.” 

He said the best prescription to address the country’s complex health challenges is an affordable and robust primary health system that can mitigate many of our health challenges brought on by the impacts of poorly managed non-communicable diseases like hypertension, diabetes and cancers undiagnosed in the earlier stages of clinical presentation. 

Dr. Darville said this universal challenge was brought to the forefront by the Pan American Health Organization 30^th Sanitary Conference in Washington D.C . a few weeks ago, and confirmed at the recent Cuban Health Conference.

“For this reason, I am introducing the National Health Insurance Bill, 2022 which will modernize the NHIA’s legislation to meet the current realities of the Bahamian health system.”

He said, “This bold move will certainly bring together both public and private clinical practices under a common financing structure that rewards performance quality and service excellence.” 

Dr. Darville said the new NHI Bill will lay the legal framework to roll out a suite of services known as the Standard Health Benefit, that all NHI beneficiaries will receive what is available now and much more.  These services include: 

• Primary Health Care Services 

• Health Education and Promotion 

• Early Detection and Preventative Care 

• Diagnostic Imaging 

• Pediatric and Maternity Care 

• Screening Programs for Cancer and Other Specified Conditions 

He explained that the new Bill will lay the foundation for the launch of Catastrophic Care coverage, which is a priority for the administration.

The Health Minister said this piece of legislation will prove to be a critical step for the expansion of primary healthcare benefits along with robust health and wellness programs across the country as the government pushes toward universal health coverage.

He said through this proposed Bill, all private insurers that offer health insurance plans in the country will be required to offer the newly purposed Standard Health Benefit package as a minimum standard of coverage. 

Dr. Darville said in this sense, NHIA will assume the role of the insurer of last resort and will protect the poorest and most under-served communities. 

He also noted that in addition to introducing the Standard Health Benefit as the minimum standard for all health insurance plans in the country, this legislation will expand the network of providers to deliver services. 

Dr. Darville said, “But let me reassure the general public that these providers will need to meet the Authority’s high-quality standards and they will not be a part of this entire process unless they prove to be in good standing with our medical licensing agencies.”

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How Could ObamaCare Help The Bahamas?

The Importance of National Health in The Bahamas

Moving Forward With A National Health Care System For The Bahamas

By Dr Kevin Alcena

“The... patient should be made to understand that he or she must take charge of his own life. Don't take your body to the doctor as if he were a repair shop.” (Quentin Regestein)

This article will attempt to show the readers in an objective systematic way, an analysis of the importance of national health in The Bahamas in the form of a parisology.

“To enjoy good health, to bring true happiness to one's family, to bring peace to all, one must first discipline and control one's own mind. If a man can control his mind he can find the way to Enlightenment, and all wisdom and virtue will naturally come to him.” (Buddha)

“The chief condition on which, life, health and vigor depend on, is action. It is by action that an organism develops its faculties, increases its energy, and attains the fulfillment of its destiny.” (Colin Powell)

A National Health System coupled with good system planning would benefit the Bahamian society in a very diamantiferous way. We have to have a saxicoulus acephalous mandate for our health system for a generation that precedes us.

We must be smarter than the Americans and more diligent and transparent than the British. A comparative study of the two health care systems – The USA and The UK - conducted by some researchers a few years ago revealed that:

“According to a 2006 OECD comparative data study, the total health expenditure in 2004 by the United Kingdome was 8.3% of their gross domestic product (GDP), and the United States was 15.3% of their GDP - whereas the mean of 30 countries was 8.9%. This same study reports health expenditure in the United Kingdom as US $2,546 per capita, and US$6,102 per capita in the United States, - whereas the 30 country mean was US $2,550.

Not surprisingly, public spending differs quite significantly between the United States and the United Kingdom as well. Of their respective 2004 total health expenditure public spending - in the United States was 44.7% - whereas the 30 country mean was 73%.” (The Health Care Manager, Volume 26 Number 3).

The Bahamas can also learn a lot from the Swiss and Rwandans Health system. For example, “Rwanda’s health sector has undergone a fundamental transition in the last century; in the time before colonial era, health care consisted of traditional African healing methods. The German and later Belgian colonial period saw the emergence of faith-based health care, and with it - the introduction of modern treatment methods.” (Rwanda National Health Sector Policy, 2005).

We have to be very innovative and creative. The most important element in implementing a health system in the Bahamas is a health information system.

“A national health information system (HIS) plays an important role in ensuring that reliable and timely health information is available for operational and strategic decision making that saves lives, and enhances health. Despite its importance for evidence-based decisions, health information systems in many developing countries are weak, fragmented and often focused exclusively on disease-specific program areas.” (http://www.who.int/.../1HMN_Architecture_for_National_HIS...).

“Health care in Canada is delivered through a publicly funded health care system, which is mostly free at the point of use, and has most services provided by private entities. It is guided by the provisions of the Canada Health Act of 1984.

The government assures the quality of care through federal standards. The government does not participate in day-to-day care - or collect any information about an individual's health, which remains confidential between a person and his or her physician.

Canada's provincially based “Medicare systems are cost-effective - partly because of their administrative simplicity. In each province each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private insurance is only a minimal part of the overall health care system.” (Wikepedia)

Hippocrates, the Greek Father of Medicine once said, “A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.”

Health care is not a new phenomenon. Imhotep the Father of Medicine, was not just an imaginative architect; he was also a doctor and philosopher of the human body and mind and he contributed to medicine in a number of ways:

• “Imhotep's concepts included specializations in many methods of medicine, compared to today's physicians who primarily master one area of expertise. He introduced a blend of new methods including astronomy, philosophy, religion and protective amulets to achieve new breakthroughs.

He was a pioneer in helping to develop tracheotomy to resolve respiratory obstructions, cauterization to circumvent excessive bleeding while operating, and blood drainage to cure diseased collections.

• Imhotep diagnosed and treated hundreds of diseases including diseases of the abdomen, the bladder, the rectum, the eyes, and many of the skin, hair, nails and tongue. He treated tuberculosis, gallstones, appendicitis, gout and arthritis.

• A very significant resource of today's modern medical practices is irrespective of Imhotep's medical school; medical tools such as forceps, scissors and surgical blades were all imitative of ancient Egyptian medical apparatus. And certain remedies for elementary disorders that were introduced from ancient Egypt medicine are still practiced today; castor oil for laxatives, honey as an antimicrobial and Acacia as a cough remedy all are in retrospect of Imhotep's teachings and forward-thinking medical protocols.”

Imhotep’s most famous quote was "Eat, drink and be merry for tomorrow we shall die." Of course this is quite ambiguous today as we know diabetes, and hypertension is affecting the global health system like it is nobody’s business, and the general population of our global family is suffering as a result of their eating and drinking habits. Redd Foxx was also sardonic when he said, “ Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.”

According to the statistics posted by the World Health Organization for 2011:

• 346 million people worldwide have diabetes.

• In 2004, an estimated 3.4 million people died from consequences of high blood sugar.

• More than 80% of diabetes deaths occur in low- and middle-income countries.

• WHO projects that diabetes deaths will double between 2005 and 2030.

The inexplicable global health system in regards to obesity and hypertension has impacted all governments in the world in a negative way. Obesity is a resipiscence because it is one of the biggest health problems in the world due to our lifestyle of food choices.

There is a global war on obesity and health experts are stentorophonically crying out to the world’s citizens to stop this trilemma because it is killing us and putting a great strain on the health system. Some statistics taken from the World Health Organization points out that:

• Worldwide obesity has more than doubled since 1980.

• In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.

• 65% of the world's population live in countries where overweight and obesity kills more people than underweight.

• More than 40 million children under the age of five were overweight in 2010.

• Obesity is preventable.

“Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” (World Health Organization, 1948).

How would ObamaCare help The Bahamas?

It is quite simple. America leads and the world follows.

It is all indication that there is a new pedagogy in the global health system. ObamaCare will ignite the consciousness of leaders to implement a comprehensive national health service in their respective countries in a bombastic way.

Take a look at Cuba for example. “The Cuban health care system is respected around the world, and is literally decades more advanced than any system found in Latin America. For this reason, the Cuban system serves as a model for Third World developing nations.” (http://library.thinkquest.org/18355/health_care_in_cuba.html)

In conclusion, we in The Bahamas have an opportunity to model our health system with the best management team in our country. National health should be run by a quasi government corporation that compliments strategical business sense in the protocol of them delivering quality health service in a circumambagious way.

“The greatest wealth is health.” (Virgil)

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The Bahamas Infant Mortality Rate Increases

Official Opposition Leader, Hubert Ingraham raised alarm over The Bahamas Infant Mortality Rate increase by stating that efforts by his administration drove the infant mortality rate from more than 24 per thousand live births to below 12.

"We expected to bring it to single digits by 2004," he said.  "Instead, under this neglectful government it has risen again to 19 per thousand live births.  Why are we moving in reverse?"

Infant Deaths Climbing

By Candia Dames

Nassau, The Bahamas

26 April 2006

Statistics from the Ministry of Health’s Information and Research Unit confirm a recent claim made by Opposition Leader Hubert Ingraham that the country’s infant mortality rate is on the way up.

Mr. Ingraham raised alarm over the increase Monday night saying that efforts by his administration drove the infant mortality rate from more than 24 per thousand live births to below 12.

"We expected to bring it to single digits by 2004," he said.  "Instead, under this neglectful government it has risen again to 19 per thousand live births.

Why are we moving in reverse?"

The infant mortality rate is considered internationally to be a sound indicator of a nation’s health and development.

Information from the Ministry of Health, however, does not provide any evidence to show that the figure has risen to 19.  The most recent data available is for the year 2004 when the rate was 17.3 deaths per 1,000 births, up from 12.7 deaths per 1,000 in 2001.

Minister of Health Dr. Bernard Nottage was not available yesterday to comment on the matter, as Tuesday is a day when the Cabinet meets most of the day.  But in a press statement issued early yesterday, he responded to Mr. Ingraham’s claim by saying only that there is no connection between the infant mortality rate and a shortage of vaccines.

No other health official would return the Journal’s calls yesterday either, but the Journal was able to obtain a copy of what is reportedly the minutes of a meeting of health officials that took place on Friday.

In the minutes, a senior nursing officer stated that the meeting had been called to discuss the minister’s mandate to strategize ways to reduce the infant mortality rate and the maternal mortality rate "as both were on the rise".

Officials reportedly plan to convert the Blue Hill Road Clinic into a Child Health facility, while Flemming Street Clinic will be converted into a Women’s Health Clinic, run by midwives.

The senior nursing officer quoted in the minutes impressed upon the midwives that should the need arise, they should inform persons inquiring about the vaccine shortage that supply should be available in about two weeks.

She said that the midwives should explain that the government does not owe any money for vaccines, but that there was a misunderstanding between the Ministry of Health and the Pan American Health Organization (PAHO), which has since been cleared up.

In its statement to the press yesterday, the Ministry of Health acknowledged that there is a shortage of supply of the Measles Mumps Rubella (MMR) vaccine due to an error in the billing by its suppliers.

The ministry said through no fault of its own, the suppliers had failed to send an invoice for some $865 and held up the latest order when they did not receive payment.  It is this mistake, the ministry said, which was corrected as soon as it was discovered.

"I am happy to report, however, that an inventory has been carried out, which confirms that we do have in stock a supply of all vaccines, including MMR, although some individual clinics may not have supplies in their possession," Dr. Nottage reported in that statement.

"Additionally, there is a shortage of one of the components of the Pentavalent vaccine, and that is due to the fact that the manufacturer sent us supplies with differing expiration dates.  There is no shortage of Polio, Diphtheria, Pertussis or Tetanus vaccines, all of which are in adequate supplies."

Dr. Nottage indicated that his ministry had made arrangements to obtain those vaccines that were in short supply and expected the delivery of those vaccines yesterday, which should be available to the public today.

But as mentioned, the statement said very little about the infant mortality rate.

In the health meeting minutes, another senior nursing officer in response to queries from the midwives present regarding the shortage of family planning/contraceptive methods said that there were no monies available for the purchase of these methods.

She indicated that at present her unit had only one inject - able method and few oral methods available.  The senior nursing officer said she would seek permission to inform clients of the situation via mass media or by notices posted in the clinics to avoid a disclosure similar to that made by Mr. Ingraham regarding the vaccine shortage.

The Promised National Health Insurance (NHI) Plan in The Bahamas

No Definite Plan on How National Health Insurance Would Be Financed in The Bahamas

Timing of National Health Insurance Remains Uncertain

By: Candia Dames

candiadames@hotmail.com

Nassau, The Bahamas

21 October 2005

It remains unclear whether the government will establish the promised National Health Insurance Plan before the end of this term, but Prime Minister Perry Christie said on Wednesday that he is still committed to making such a scheme a reality.

The National Health Insurance Plan was a major campaign promise of the Progressive Liberal Party in 2002, with Mr. Christie continuing to tout the importance of it as prime minister.

Early in his term, he appointed a 15-member Blue Ribbon Commission on National Health Insurance, headed by Dr. Perry Gomez, to examine the feasibility of such a scheme.

On Wednesday, Member of Parliament for South Andros Whitney Bastian asked Prime Minister Christie whether national health insurance will be in place before the end of this term.

It was a question that the prime minister failed to answer in any specifics, saying only that Cabinet will make a decision on that.

He did, however, point to the "urgency" of looking into such a plan.

"From a personal point of view I wanted it to happen," he said.  "Cabinet obviously has to make a decision on it.  It is something that I heralded from the platforms during the last campaign.  It is something that I have always believed to be of vital importance to the poor of this country."

Mr. Christie said the recent poverty study tabled in the House of Assembly by Minister of Social Services and Community Development Melanie Griffin is evidence that there is a significant portion of the population desperately in need of national health insurance.

The poverty study found that just under 10 percent of the population is living below the poverty line.

"Poverty obviously creates a real problem in our country, particularly as you go to the islands," the prime minister acknowledged.  "When you reach Andros and go farther south it’s from 12 percent to 20 percent."

The prime minister did not give a timeline, but he said that he will make a communication to parliament as soon as his government makes a decision on national health insurance.

Dr. Gomez told The Bahama Journal several months ago that the government had appointed a planning committee to formulate specifics as it relates to national health insurance after signing off on all of the recommendations of the commission.

But while the committee was working aggressively to come up with the right formula for the scheme, it had not yet come up with a definite plan for how national health insurance would be financed, he said at the time.

Nevertheless, he indicated that the plan is no longer a matter of "if", but "when".

"The social health insurance levels the playing field in health," Dr. Gomez told The Bahama Journal.  "I believe that health is a right of individuals, not a gift; it’s not a privilege.  All people are entitled to the best of health care that their countries can afford, regardless of the individuals’ ability to pay.

"That’s a problem we have in our country to a large extent.  There is a discrepancy between the health care of the haves and those who have not and I think the best way of trying to address this issue is by finding some means of insuring the entire population and the best way to do that from all I have looked at and the Blue Ribbon Commission has studied is through this programme of social health insurance."

At the time, Dr. Gomez indicated that the development of the scheme is "highly technical" and he indicated that one of the more difficult challenges faced by authorities is coming up with a cost structure for the plan.

The Bahamas is The Only Country in The Region that is Witnessing A Downward Trend in New HIV Cases

Anti-AIDS Education Programme Yields Positive Results Throughout The Bahamas

New HIV Cases Decline 

By Candia Dames

candiadames@hotmail.com

Nassau, The Bahamas

15th November-2004

The number of new HIV cases reported in 2003 declined for the third consecutive year, but health officials say there are still serious concerns regarding the spread of the deadly virus in the country.

Last year, 289 cases were reported.  This compares to 332 in 2002; 385 in 2001 and 404 in 2000, according to newly released numbers from the Infectious Disease Division of the Princess Margaret Hospital and the Department of Public Health.

The most recent figure is also the lowest number of cases reported in a given year since officials reported 710 cases in the period 1986-1988.

Director of the HIV/AIDS centre Nurse Rosa Mae Bain reported that The Bahamas is the only country in the region that is witnessing a downward trend in new HIV cases.

She believes this positive trend has resulted from a consistent anti-AIDS education programme throughout The Bahamas.

“We’re marketing the condom use because it’s crucial that everybody who has sex with somebody knows the status of their partner,” Nurse Bain said.  “If they don’t know, then they need to protect themselves with the condom.”

Her department is also getting set to launch a marketing campaign promoting the use of the female condom.

“They’ve been available for a while, but we’ve not really pushed it,” she said.

Officials of the National AIDS programme have also expanded their outreach in schools, working with grade six students encouraging them to delay the initiation of sexual activity.

“What we are also doing is training them if they are sexually active to protect themselves, that is crucial.  They need to know about the availability of condoms, how to store them; how to use them; how to put them on and how to take them off,” Nurse Bain said.

The new numbers also show that the sexually active age group 15 – 44, continues to be the main group of people infected with the virus that causes AIDS.

AIDS is the leading cause of death in the age group 15 – 29.

The National AIDS programme has monitored the epidemic since 1983.  As of December 31, 2003, there was a cumulative total of 9,725 total HIV infections, 4,758 cases of AIDS and 4,697 persons who are non-AIDS HIV positive.

Of the total 4,758 cases of AIDS, 3,309 have died.  Of the total 9,725 infections, 6,920 occur in young adults between the age group of 15 – 44.  The ratio of males to females infected with HIV is now 1:1.

Nurse Bain said there is still a serious concern as it relates to older men passing the virus on to young girls.

It’s a dilemma authorities continue to tackle.  They say because of the high numbers of single mother homes, many girls are often easily enticed by material possessions and are therefore more inclined to have sex with men who can provide these things.

“We’re very well aware that approximately 70 percent of our babies are born to single parents,” Nurse Bain said.  “Because of that, within the home-setting, there is not the male figure…we want to send a message out there, ‘Older men, please leave our young girls alone.’”

There is another practice of grave concern.

Nurse Bain said there are many girls who are engaged in rectal sex as protection from getting pregnant.  They also see it as a way of having sex and remaining virgins.  But she said there is serious danger in this practice.

“Once the lining of the rectum is torn and somebody has HIV, [men] can pass that on very, very quickly to our young girls,” she said.  “This is a concern for both male and females.  Next to blood transfusion, rectal sex is the easiest way to get HIV infected.”

The first clinical case of AIDS was reported in1983 and confirmed on post mortem in 1985.  The first confirmed case of AIDS was reported in The Bahamas in August 1985 when antibody elisa testing became available, according to the Bahamas National HIV/AIDS Programme.

The Bahamas has the highest annual incidence rate of AIDS in the English speaking Caribbean, and is among the three nations with the highest incidence rates in the world.