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

Implementing both value-added tax (VAT) and a contributory National Health Insurance (NHI) scheme cannot co-exist

NHI ‘too much too fast’ given VAT

Head of Coalition for Healthcare Reform says ‘only so much’ private sector can bear, as NHI steering committee moves ahead

By ALISON LOWE
Guardian Business Editor
alison@nasguard.com

As a government-appointed steering committee on National Health Insurance (NHI) ramps up its activity surrounding the potential implementation of the healthcare initiative, a former chamber of commerce president has warned that implementing both value-added tax (VAT) and a contributory NHI scheme cannot co-exist.

Winston Rolle, former chamber of commerce president, and a former head of the Coalition for Healthcare Reform, a private sector group formed to highlight concerns surrounding the possible implementation of NHI prior to the end of the last Christie administration in 2007, said there is a limit to how much the private sector can bear in the form of taxation.

“There were seven or eight guiding principles we’d said we need to look at before we can talk about modernizing our health system and I don’t see where that position would’ve changed.  It still boils down to one, cost, and two, who’s going to pay for it?

“Obviously with the changes that would’ve taken place in this fiscal year, with the business license fee and now with talk of the implementation of value-added tax (VAT), and another scheduled national insurance increase coming up as well now, you are talking about yet another expense that has to be borne by the citizenry and the business community.  There’s just only so much that they can take.  I think it may be a case of trying to do too much too fast,” said Rolle.

Arguing that “putting in place a system that can’t meet the objectives would be just as bad as what you have now”, Rolle suggested that the government has to take into consideration “not only VAT but the whole taxation system” and ensure that those who are required to “pay for this cost have the ability to pay”.

His comments come as Guardian Business understands the government’s steering committee on NHI has begun to meet every two weeks as it attempts to move the NHI agenda forward.

In October, Minister of Health Dr. Perry Gomez said that implementing NHI remains a priority for the Christie administration.  He suggested that an updated costing of the roll out of the initiative would be completed by the end of the month.

Meanwhile, the government is forging ahead with controversial plans to implement VAT at a rate of 15 percent by July 2014, in an effort to address a spiraling debt situation and respond to calls from the World Trade Organization (WTO) to phase out high import tariffs, a key source of government revenue.

Yesterday, sources close to the government’s steering committee on NHI revealed that the group, which was appointed in July of this year, has begun to meet once every two weeks and has already provided a document outlining the terms of reference for NHI to Gomez.

Gomez himself, described as a “passionate advocate for equity in access to healthcare” by sources close to the committee, is said to be keen to see the initiative move forward, addressing the rising cost and inaccessibility of healthcare to many Bahamians.

While the minister had earlier suggested that the updated costing for NHI – how much the government would need to cover the launch and maintenance of an expanded publicly-funded healthcare program – would be complete by last month, Guardian Business understands that this element of preparation is yet to take place.

Guardian Business understands that among those on the steering committee, who include Edison Sumner, president of the Bahamas Chamber of Commerce and Employers Confederation (BCCEC), and John Pinder, president of the National Congress of Trade Unions of The Bahamas (NCTUB) and the Bahamas Public Service Union (BPSU), there are some reservations about the feasibility of implementing NHI given government’s intentions to move ahead with VAT in particular.

It is believed that among the suggestions emanating from the committee are the possibility for the government to implement NHI in phases, with an appreciation for the fact that such a staged implementation – rather than the immediate launch of a comprehensive national health system ­– would more closely approximate what has happened in other countries.

Meanwhile, it has been suggested by sources close to the process that based on the current progress with respect to NHI, the full costing of the initiative may not be completed until next April.

Rolle said he has not been personally informed of any specific advancements in the NHI agenda, but suggested that the government must ensure it seeks the input of the private sector as it moves forward.

“The same parties who were involved in 2007 would want to have sight of and have input into anything that comes up,” he said.

December 03, 2013

thenassauguardian

Caribbean Blog International

A National Health Insurance (NHI) scheme would only work efficiently if, and only if, there are proper checks and balances in place ...especially to ensure that the pool of money goes in to a segregated fund for health and health alone...

The National Health Insurance debate

CFAL Economic view

We read recently in a local daily that Dr. Perry Gomez, the Progressive Liberal Party (PLP) candidate for North Andros and the Berry Islands said that under a PLP government National Health Insurance (NHI) would be implemented within the first year of coming to office.  While we are in the so-called ‘silly season’ and everyone and their brother are making promises, we would hope that some of the promises would be well reasoned outlining the attended cost and consequences for the wider community; the usual rhetoric is just not acceptable this time around.  We believe that members of the Bahamian electorate are a bit more discerning than most politicians give them credit for.

What is NHI?

The issue of a National Health Insurance was first raised back in August 2002, when then Prime Minister Perry Christie appointed a 15-member Blue Ribbon Commission to review the feasibility of a National Health Insurance Plan.  The committee was also mandated to determine the best way to make affordable healthcare available to all residents.  The appointment of the committee was a step towards the fulfillment of the then government’s promise to ensure that all patients receive the same access to healthcare regardless of their personal wealth or circumstances as outlined in the PLP’s manifesto, ‘Our Plan’.  In 2004, the final report was released.  It was the view of the committee that The Bahamas cannot afford to not have a National Health Insurance (NHI) scheme.  The committee also stated that NHI had to be mandatory and would only work if the government had adequate funding.   We have no difficulty agreeing with those observations but would urge the authorities and the public to take a closer and more objective look at the proposal.

What is National Health Insurance?  National Health Insurance is a form of social health insurance, which uses the principles of fund pooling and risk sharing to provide equity in access to care.  Individuals pay an ‘affordable’ amount on a consistent basis and in return are able to have their healthcare needs provided for, regardless of cost.

It is envisioned that this ‘cradle to the grave’ national healthcare coverage will cover persons who are currently excluded from private insurance plans such as individuals with pre-existing illnesses, newborn babies and those over 65.

The 125-page NHI report outlined the following eight specific recommendations for the Cabinet’s consideration:

1. National Health Insurance should be universal.

2. Legislation should stipulate the health insurance is compulsory for all residents.

3. National Health Insurance should be administered by the National Insurance Board.

4. A comprehensive benefits package should be offered.

5. Contributions should be set at a rate which is affordable for the majority.

6. Public and private providers should be offered the opportunity to join the National Health Insurance system.

7. All provider payment mechanisms should be considered for use with capitation being the preferred option.  (Capitation is a provider payment mechanism in which providers are regularly paid a stipulated amount per person for whom they agree to provide services during a defined period of time.)

8. A percentage of revenues should be set aside for purposes that ensure the stability of National Health Insurance.

The present system in The Bahamas, which employed persons contribute to, is a form of social security.  Our health system includes tax-funded care through government hospitals and clinics, and private care funded by direct user fees or private insurers.  The incentives that exist include pension, invalidity assistance, medical incentives, maternity benefits, some income replacement, temporary and permanent disability benefits, and health coverage for occupational injuries.  Basically, social health insurance currently exists only through the industrial injury component of NIB.

Recently, the present government implemented the National Prescription Drug Plan to assist some Bahamian residents, particularly the elderly and children under the age of 18 years.  It is estimated that the cost of this program is currently running around $5 million; a figure which we expect to only increase in the future.

Healthcare costs are one of the more vexing and challenging issues facing countries today and according to the latest information on the subject, average cost in the last five years increased annually by more than 10 percent.  With rapidly aging populations and the rising costs of modern medical technology, governments everywhere are finding it increasingly difficult to provide the funds required to meet healthcare needs of their respective populations.  Given that position, we would hope that before any decision is made to move forward with universal health coverage, the authorities would prepare a detailed cost analysis to use as a guide.  To do otherwise, we run the risk of committing to something which could surely place The Bahamas on an irreversible path to economic poverty.

Prior to 2008, it was estimated that only 51 percent of Bahamians had private health insurance.  Today, given the challenging global economic environment, the impact on the local economy and increasing levels of unemployment, we estimate that number at around 40 percent based on the increasing payouts by insurance companies.  For some, private insurance has become too expensive; persons in the lower income bracket and those living on the Family Islands are now less likely to have insurance coverage.

There are a number of questions that need answers.  How much will this plan cost?  (Back in 2004 estimates were pegged around $200 million-plus, which we felt were too low at that time).  Who will pay for those who cannot afford to pay?  What will be the impact on the private insurance industry?  What impact will it have on the fiscal deficit?  (This should be of particular relevance to future generations).

Concerns remain

Historically, the Bahamian government has been a principal source of financing environmental and healthcare expenses for citizens of The Bahamas with an annual expenditure of over $267 million in the 2011/2012 budget or nearly 16 percent of total recurrent expenses which computes to almost four percent of the country revised GDP (another story for another day).

It is estimated that the private insurance companies spent nearly $230 million in 2011, which gives us a total healthcare expenditure bill of nearly $435 million or 5.4 percent of the revised GDP.  In the 2004/2005 fiscal budget, the government allocated approximately $187 million for health expenditure.  In 2004/2005 it was estimated that healthcare expenditure stood at approximately $340 million or 7.10 percent of GDP, of which $70 million was spent by the people, $102 million spent through private health insurance, and the rest by the government.  In comparison, in 1985, total public expenditure amounted to approximately $56 million or only 2.70 percent of GDP.

It is our view, based on historical cost data and future projections, that the cost of a national healthcare plan going forward would be in the region of $500 million to $750 million; equivalent to nearly half of our recurrent expenditure and as such, would not leave much room for other important infrastructure projects.

We generally agree with the conclusion of the commission’s report that a social health insurance system for The Bahamas would provide more equity in access to healthcare, more stable funding of public health costs, and fewer ‘free riders’, or people who benefit without contributing.  Setting up such a national healthcare system involves more than just taxing the people but will require legislation and the creation of responsible bodies.

Two critical issues are ensuring compliance and public accountability.  We are also mindful, however, that there are those who have little faith in governments operating such healthcare initiatives due to a propensity for such operations to become instruments of political patronage and the widely shared view that government institutions are relatively poorly managed.  In the last analysis, we believe that the scheme would only work efficiently if, and only if, there are proper checks and balances in place especially to ensure that the pool of money goes in to a segregated fund for health and health alone.

•CFAL is a sister company of The Nassau Guardian under the AF Holdings Ltd. umbrella. CFAL provides investment management, research, brokerage and pension services. For comments, please contact CFAL at: column@cfal.com

Mar 07, 2012

thenassauguardian

Caribbean Blog International

Dr. Duane Sands: I support National Health Insurance (NHI)

By Candia Dames ~ Guardian News Editor ~ candia@nasguard.com:




In 2006 when the debate over National Health Insurance (NHI) was raging, Dr. Duane Sands emerged as a key opposition voice to the plan as presented by the Christie administration.

Today, as the Free National Movement's candidate in the approaching by-election, Sands is making headlines for other reasons, but his opponents are quick to remind voters that four years ago he fought the battle against the highly touted program.

"My impression was he did not support National Health Insurance," said Dr. Bernard Nottage, who was minister of health in 2006 and is now the Progressive Liberal Party's coordinator for its Elizabeth by-election campaign.

"Indeed, my impression was he did not support universal health insurance. Dr. Sands is an influential physician who has worked in our system in both the private and public [sectors] for many years. And he knows the weaknesses and the faults of the system. He knows that there are people in this country who when they fall ill are denied care because they do not have the money to pay."

Sands on the other hand suggested that because he has worked in the system for such a long time, he has a good idea of what is realistic and what is not. And what the PLP was proposing in 2006, he said, was just not realistic.

"It's interesting that much of what is being said about me now is that I opposed National Health Insurance (NHI)," Sands said yesterday. "There's nothing further from the truth. I did not oppose National Health Insurance. I didn't then and I don't oppose it now.

"What I did oppose was something that was poorly conceived and likely to be poorly executed, and I thought that we were trying to sell the Bahamian public a bill of goods for political mileage. I say that without fear of contradiction. At the time, when I was a technical person in the Ministry [of Health], I said this cannot work, this will not accomplish what it is setting out to do."

In 2006, Sands was part of the National Coalition for Health Care Reform.

Back then he said, "I have absolutely no problem with a National Health Insurance Plan.

"I think it should happen now. I think we need to make dramatic changes in the way health care is delivered. We need to improve access for our Bahamian people, but I've gone on record, and I go on record today, as saying this plan as currently touted will not do what it's intended to do, and more importantly, I believe that we're not terribly far off from the proponents of the current [proposed] National Health Insurance Plan.

"I believe that there's enough talent in this country that if we sit down together and hash out the differences we can all develop a National Health Insurance Plan which we can be proud of, which would be sustainable and which would achieve the noble goals set out by the Blue Ribbon Commission [on National Health Insurance]. We're not terribly far off."

When the National Health Insurance Bill came to Parliament in 2006, Free National Movement members supported it, although they repeatedly pointed to what they called flaws in the Christie government's NHI plan.

In his contribution to the debate on December 6, 2002, then leader of the opposition Hubert Ingraham pointed out that the bill would not have created NHI.

"If, according to them (the PLP) people are dying because there is no National Health Insurance, then people will continue to die because this bill is most certainly not delivering National Health Insurance," Ingraham said.

The bill was passed, but had a short shelf life as it came mere months before the Christie administration's one term in government ended. Under the Ingraham administration, talk of NHI has taken on new form.

The government has said its national drug prescription plan is the first step to NHI and that there will be other steps in its planned phased approach, although no timelines have been given.

But Nottage is doubtful that any meaningful National Health Insurance Scheme will ever develop under the current administration.

"If poor people can't afford it now, how are they going to be able afford it in the future unless there is a national system which we were trying to implement, a system by the way which requires every person who is employed to make a contribution toward health care in the country, pooling the resources so that everybody pays and when one of us becomes ill [we] would not have to worry about having the cash to pay," he said yesterday.

The former health minister said some members of the medical profession are ambivalent about National Health Insurance.

"They want people to have good health care but they don't want to make the sacrifices that are required for them to have good care," he said. "And some of those sacrifices include having to forgo many of the benefits that health professionals have, and so I think it is that ambivalence that has created this opposition."

Sands said in 2006 that he is prepared to work with anyone to come up with a plan that will be sustainable and realistic.

Yesterday he said, "Let's not offer people something that it isn't. National Health Insurance, universal health care, health care reform are emotionally charged buzz words because health care is so critical in a personal way and in a national way. You've got to be very careful that you don't take people's emotions and run with them in a way that you hold out something that is not real. That's lying to people.

"What you need to be able to do is say 'here's where we are, here's where we'd like to go and we think this is where we can get to'. You've got to be honest. I think people understand and appreciate honesty."


February 11, 2010


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Bahamas Blog International