The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Bahamas Insurance Association’s (BIA) chairman yesterday said it was impossible for the Government to currently develop an accurate cost for its National Health Insurance (NHI) scheme because it possesses none of the necessary data.

Emmanuel Komolafe told Tribune Business that the claims information possessed by the private insurance industry, which accounts for an estimated 50 per cent of total Bahamian healthcare spending, had yet to be passed to PricewaterhouseCoopers (PwC).

He explained that this was due to delays on the Government side in signing-off on a Non-Disclosure Agreement (NDA) that would govern how the information was used.

And he queried where “the other 50 per cent” of data required by PwC was coming from, given the absence of electronic, quality information in the public healthcare system.

Mr Komolafe’s comments effectively suggest that PwC, as the Government’s consultants, has virtually none of the information required to determine an accurate cost for NHI bar what was contained in the reports by its other advisers, Costa Rica-based Sanigest Internacional.

Yet Prime Minister Perry Christie on Wednesday said the Government will “shortly” have NHI’s likely costs, and that PwC was doing a “special exercise” on the subject as he spoke.

That is contradicted by Mr Komolafe’s comments, while a Bahamian doctor, speaking on condition of anonymity, said PwC had told the Medical Association of the Bahamas (MAB) that “we can’t do it without you guys and the insurance industry”.

The doctor added that the accounting firm had also asked the MAB to “push for more actuarial assessments of what’s going on”.

Mr Komolafe, meanwhile, said the combined health claims data from underwriters such as Colina, Family Guardian and Atlantic Medical showed where insurance monies were being spent within the healthcare industry.

Around 50 per cent of the Bahamian population is covered by some form of health insurance, with the private healthcare sector accounting for around half this nation’s annual $800 million healthcare spend - thus making it vital to any NHI costing exercise.

Mr Komolafe said PwC and Peter Deveaux-Isaacs, the NHI permanent secretary, had in meetings acknowledged the importance of the private health insurance industry’s data, with the latter willing to help provide it.

“From my perspective, I don’t think so,” Mr Komolafe replied, when asked by Tribune Business whether the Government possessed enough information to do an accurate NHI cost assessment.

“When you look at it, there are two main sources of getting data in the Bahamas - the private sector, and the public sector. On the public side, there are challenges with getting that data.”

By paying claims and interacting with the medical industry, Mr Komolafe said the private health insurance sector was able to determine the expenditure associated with different medical services, something that was “pivotal” to helping determine NHI’s costs.

However, the NDA between the Government and private insurers over how that data is to be used by PwC has not been concluded, with no information exchanged as a result.

“We’re very anxious to assist in this process, because we know how critical it is to getting the costing right,” Mr Komolafe told Tribune Business.

“The other 50 per cent of the data, where do you get that from? One of the major challenges [in the public sector] is the electronic documents. We have serious challenges there.

“At this stage, a lot of persons in the [insurance] industry have no idea what’s going on, especially with the costing.”

Such concerns were expressed forcefully in PwC’s original NHI report, which said hospital usage rates in the Bahamas - and their drivers - “are not well understood”.

Referring to the public healthcare system, it added: “There is simply an absence of quality data. The issues with the data quality are mostly related to the lack of accurate hospital coding and costing systems.”

PwC also warned that the switch to NHI’s new payment system would prove problematic for the Public Hospitals Authority (PHA), as “none” of the foundations to facilitate the change - reliable information on costs, records and patient information systems - “exist within the PHA at this time”.