The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A Cabinet Minister yesterday pledged “there’s not going to be an NHI information black hole” amid private sector concerns about insufficient details to justify the scheme’s pricing.

Dr Duane Sands, pictured, minister of health, told Tribune Business that “if I have anything to do with it” the studies showing how the $1,000 annual premium for National Health Insurance’s (NHI) minimum level of care was calculated - and the scheme’s projected economic impact - will be released to the Bahamian public.

He spoke out after the Bahamas Chamber of Commerce and Employers Confederation (BCCEC), the group that represents the widest cross-section of Bahamian businesses and industries, said it was “extremely concerned” about the lack of empirical data to support how the Standard Health Benefit’s (SHB) premium cost was derived.

Michael Maura, the Chamber’s chairman, expressed fears that Bahamian businesses could be called upon to pay ever-increasing taxes to finance NHI if the Government had got its sums over the SHB premium wrong.

“It cannot be the business community that has to fix it by providing greater funding,” he told Tribune Business. “The metrics are critical. The challenge we have, while undoubtedly a lot of good work has gone into the concept of NHI, we feel there’s not sufficient analysis and real model data to help us understand what will be the impact to businesses and people who enrol in the plan.

“We appreciate the intent, but in our view there is insufficient analysis to help us. The Government is making it very clear this [NHI] is a national objective; we get it, we buy into it, but we don’t have the analysis.

“The analysis has not been shared with the private sector to help us understand how we as a nation can be successful in meeting this objective and, because of that, we are extremely concerned.”

Dr Sands yesterday suggested that much of the necessary NHI costing and economic impact modelling had been performed by consultants hired under the former Christie administration, and that it made little sense to “discard” work that had already cost Bahamian taxpayers millions of dollars.

He argued that it was “a bit of a stretch” to call for this work to be done again, asking “to what end” would this achieve anything except burden the Public Treasury with more costs at a time of fiscal austerity.

The Minister also responded to the Chamber’s assertion that it was “unfair” to single out “sugary drinks” for taxation that could help to finance NHI, urging it to recommend other unhealthy food and beverage products that could be subjected to such levies as part of its call to broaden the base of so-called “sin taxes”.

Asked whether the Government will share information to address the Chamber’s remaining NHI questions, Dr Sands told Tribune Business: “Let me say to you very candidly: This administration has made it a significant philosophy that we are going to be transparent, particularly as it relates to fiscal matters.

“The Fiscal Strategy Report that came out last week in the House is just one example, and any of the guiding [NHI] studies that shed some light for the public, if I have anything to do with we’d be happy to release them for public digestion and discussion. There’s not going to be a black hole where information is not made available.”

Dr Sands said the NHI Authority’s revised NHI scheme, released for public consultation last month, would have used the financing, pricing and costing work done by the former Christie administration’s consultants to help it arrive at its design.

“Bear in mind that I think some of this information will have been based on a lot of the work done previously on NHI,” he told Tribune Business. “They didn’t start with a blank slate. What they would have done is sift through a mountain of very expensive data, studies, and some of it would have been extrapolated on and used to do some modelling based on all the statistics.

“I know they would have utilised quite a lot of information gleaned in the lead-up to the roll-out of NHI in March 2017. Millions of dollars of work was done. Do you believe we’ve got to go away and re-do all these things? I think it is a bit of a stretch.”

The former Christie administration hired three sets of consultants - Sanigest International, and the PricewaterhouseCoopers (PwC) and KPMG accounting firms - to help it build its NHI care model. KPMG has since been retained by the NHI Authority under the current government.

Dr Sands said the economic modelling and assumptions underlying Sanigest’s report, including its NHI pricing and economic impact, were subsequently tested by PwC. Further work was then performed by KPMG, and he added: “There was a huge amount of work done about the economic impact of NHI.

“That then generated an action plan in terms of the readiness of hospital facilities, determination of manpower needs and so forth, and we used a lot of the data in decisions about the shortage of nurses, how many physiotherapists we need, and have used it in the ongoing construction activity in the healthcare sector.

“A lot of this has been done. To now go and do it again and do it again, I’m not sure it’s a tremendously good use of money. To say that work ought to be discarded, and the information gleaned ignored and start over, to what end?” Dr Sands queried.

“Fundamentally, the work has been done. What we’re trying to do is modify the product and determine a reasonable way of delivery and funding. If we agreed before that it’s going to cost $125-$130m, and we’re now saying how are we going to generate that $100m or so, the economic impact hasn’t really changed. All we have to determine is from where the funds come.”

The Chamber’s primary concern is that the $1,000 annual SHB premium significantly under-estimates the costs associated with providing an expanded package of healthcare benefits and services, in comparison to what is currently offered, and which now includes secondary care.

It fears this will force the Government to impose ever-increasing taxation to finance an NHI scheme whose costs continue to escalate, especially as the NHI Authority has given little to no detail on how it plans to contain costs.

Many observers, such as the Bahamas Insurance Association (BIA), have also questioned how the Government can determine the $1,000 SHB premium without yet having set up a doctors/medical services providers network for NHI and, most importantly, established a fee structure for their services.

Dr Sands, meanwhile, called on the Chamber to recommend other unhealthy foods and beverages - besides “sugary drinks” - that could potentially be taxed to finance NHI.

The Chamber’s NHI position paper said it was “unfair” to single out “sugary drinks” as this was “tantamount to the Government making a selection of market winners and losers” - an approach that the Minister described as “interesting”.

“Maybe the suggestion that I’d like to see in writing is, Ok, what else do you want us to go after,” Dr Sands told Tribune Business. “If we can get broad-based consensus from the Chamber of Commerce and business community about what else is reasonable and appropriate, it makes the process a little bit easier.

“The discussion is one that is very timely. It will be more helpful to say what their recommendation is than just say you can’t single this one out.”