The failings of the National Insurance Board (NIB) are based primarily on political interference

We need a radical change to the way the National Insurance Board (NIB) is run

A Response to Lindon Nairn's NIB proposal

By Norman Trabulsy Jr

While I am in wholehearted agreement with Lindon Nairn regarding the need for immediate and drastic action to fix NIB, I am not convinced by his proposed solutions.

Firstly, yes, the failings of NIB are based primarily on “political interference”, as he states.  Now, I would ask what is included in Mr. Nairn's idea of political interference?  Is it outright misappropriation of funds?  Is it by using NIB as a slush fund?  Is it by failing to look at the actuarial trends and responding accordingly?  Is it by political appointments of upper management who are wholly unqualified for these positions?  Is it by political interference in the collection and distribution of benefits?  Is it by political interference of the laws governing NIB, and the oversight required?  Is it by deliberate lack of accountability, and the pace of technological innovation?

I am not convinced that every public service should be outsourced to the private sector.  Private profits, as well documented in health care for instance, is what is driving the rapidly rising cost of health care.

The U.S. is a perfect example of this.  U.S. government Medicare administrative costs are 1% - 2% of revenues.  Private health insurance companies, such as our Colina, have 15%-20% administrative costs. 

It is a fact that most bankruptcies in the U.S. are because of health care costs.  Would God approve?

What some people call reckless inefficiency in government is simply called reasonable corporate profiteering by others.  Seems most of us have drank the private sector Kool Aid.

Mr. Nairn says, “ Until recently, any private citizen could simply put money into fixed deposit accounts at any financial institution and generate multiple times NIB's net earnings.”

Judging by the statistics available to all of us, what percentage of our private, average Bahamian citizens can put any money into a bank at all?  As to my knowledge, the majority of Bahamians are living pay check to pay check - unable to cover a $400.00 emergency.

Some things in this world, especially health care, should not be left to the “free market”.  Granted, here in The Bahamas we have little visionary and educational exposure to models different from our guiding light rent seekers to the north.

Not exactly a good example of Christianity in action, is it?

In my lifetime, I would be hard pressed to give examples where the private sector really did out perform previously government run services, in an educated and free society.

Instead of our government hiring the same professionals who have successfully run other similar institutions, we chose to place political hacks who have neither the intelligence, education or integrity required to lead, and then we wonder why that institution has failed.

Is this not our history in a nutshell?

You want a well functioning enterprise?  Then hire a qualified person to lead it.  Just like the private sector does.  Pay them well.  Let them hire and fire as they see fit, and leave them alone.  We will then get acceptable results.  Just like the private sector does.  Is this such a hard concept to understand?

The “heavy lifting” Mr. Nairn speaks of is not in privatizing NIB, rather it is in recognizing our own shortcomings and failings, and fixing them.  Isn't this always the heavy lifting we require?

In my estimation, not every human good or government service requires private profit to succeed.

Batelco was sold so that we would ostensibly get more efficiency and better service.  Can anyone tell me that selling BTC was not a deal made behind closed doors that enriched a handful of greedy politicians and their private sector friends?

Has service improved?  Does The Bahamas benefit from the sale of BTC in any way?

In fact, I would argue that a truly Christian perspective would see NIB, health care, life saving drugs, minimum food allowances, as God given rights that should not be touched by the money changers.

The very idea that a “company” should profit from health care should be offensive to a true, right thinking Christian.

Let the private sector gamble to their hearts delight.  But, when they cross over into essential human services, we need to let them sit small.

I agree with Mr. Nairn that we need a radical change to the way NIB is run.  That much is clear.  However, I fear that NIB, like BTC, will simply become a revenue stream for a handful of millionaire and billionaire corporate executives who have little concern for our people, and every concern for their private profits.

Norman Trabulsy Jr.
Mangrove Cay, Andros

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.”

Source

The High Cost Reality of National Health Insurance (NHI) in The Bahamas

NHI roll-out ‘could take years’

ROYSTON JONES JR.
Guardian Staff Reporter
royston@nasguard.com



While the government has said it will implement National Health Insurance in January 2016, Minister of Labour and National Insurance Shane Gibson suggested yesterday it could take several years to fully implement that plan.

Gibson, who has ministerial responsibility for the National Insurance Board, said it is “impossible” to roll out the entire plan in just over a year, but the government will introduce it in phases.

“National Health Insurance is not something that you can implement wholly on one day,” he said following a press conference to announce Public Service Week.

“You can begin the process of implementation and you would generally have to implement it in phases.

“We have some countries where it took them as much as 10 years to fully implement.

“We are looking at implementing it on January 2016, [but] it is impossible to have it implemented 100 percent on a particular day over this short period of time.”

NHI is intended to provide universal access to affordable healthcare for all Bahamians.

The first Christie administration had pegged the cost of NHI at around $235 million annually, but the government has said it will cost a lot more.

Before the May 2012 general election, now Health Minister Dr. Perry Gomez pledged NHI would be implemented within the first year of a new Progressive Liberal Party term.

Gibson said the roll-out could be similar to that of the National Prescription Drug Plan, which was introduced in phases.

Sanigest Internacional, a Costa Rican-based firm contracted by the government to advise on NHI costing, has said it is “plausible” in some scenarios for NHI to cost more than $500 million.

Asked about that figure and the status of Sanigest’s costing report, Gibson said he plans to meet with officials this week to discuss the plan.

The consultants submitted a draft report in August.

October 21, 2014

thenassauguardian