The Tribune

The Bahamas Insurance Association's (BIA) chairman yesterday said the industry remains "vehemently opposed" to the Government's 'public insurer', and slammed its National Health Insurance (NHI) consultation process as "a facade".

Emmanuel Komolafe told Tribune Business that the sector continues to fear it will face unfair competition as result of the proposed NHI 'public insurer', Bahama Care, being introduced to the market.

Its arrival, he argued, would amount to a "destabilising" nationalisation of healthcare financing in the Bahamas, with the Government placing itself into a 'conflict of interest' position via its twin roles of owner, operator and regulator.

Mr Komolafe added that the insurance industry's efforts to discuss the NHI proposal with the Christie administration had been "futile", and that the promised consultation was "more illusive than inclusive".

He also confirmed Tribune Business's Thursday revelation that the Government was 'comfortable' with the cost estimates for NHI's primary care phase, set to launch in April 2016, even though it lacked 50 per cent of the necessary data on which to make these calculations.

Speaking out after Wednesday's meeting between the private sector and the Government's NHI secretariat and implementation team, Mr Komolafe said the presentation given by the latter showed there had been no changes to its NHI model.

"The NHI model has not been altered, and the plan revealed on Wednesday confirmed the BIA's ‎concern that the consultation process has been more illusive than inclusive," Mr Komolafe said.

"This is quite unfortunate, and BIA members are of the view that the past 18 months of discussions with the Government have been futile. The often referenced meaningful consultation with the insurance industry appears to be a facade."

Mr Komolafe distinguished between NHI and universal healthcare (UHC), the latter of which is supported by both the BIA, Medical Association of the Bahamas (MAB) and the private sector.

UHC is designed to provide equal access to the same quality healthcare regardless of factors such as age and income. While NHI represents one way to finance a UHC system, Mr Komolafe said there were better models than the one the Christie administration is imposing, where the Government is the only entity providing health insurance coverage.

The Prime Minister, in his Friday address to pastors during a luncheon at the Police Headquarters on East Street, said the NHI proposal was designed to allow private health insurers "to live".

He added, though, that it was in the public interest to create Bahama Care, although he did not specify why.

Under NHI, Bahamian employers and individuals - roughly 50 per cent of the population - will have to give up their existing medical insurance coverage.

They will instead be registered with the NHI scheme, and have to purchase its Vital Benefits Package whenever it is introduced. These packages will be sold by both Bahama Care and the private health insurers in competition with one another.

"It has been stated that upon registration, individuals will be able to choose their primary care provider and insurer. However, there has been no discussion between the BIA and the NHI Secretariat in this regard," the BIA chairman said.

"Hence, it is unclear to private health insurers how they will be engaged or involved in the registration process, as well as what role they are expected to play during the first two phases of NHI."

Mr Komolafe suggested the Government had missed an opportunity to "leverage" the insurance industry's "infrastructure, expertise and systems" in designing, and implementing, its healthcare reforms.

Referring to last Wednesday's meeting, the BIA chairman said: "It was communicated that the Government is determined to enter into the sphere of the private sector via the establishment of a public insurer at the expense of taxpayers.

"We disagree with the explanation provided to justify the motivation to deviate from the traditional role of governments to legislate, regulate and enforce established rules. The BIA ‎remains vehemently opposed to the attempt to nationalise the healthcare system, and the creation of an uneven playing field which has the potential to destabilise the healthcare system and displace private sector workers.

"How can the playing field be fair where the Government passes the law, regulates and serves as a service provider, which has the perceived infinite backing of taxpayers? The primary driver of employment and economic activity should be the private sector, and entrepreneurship should be encouraged not discouraged."

Mr Komolafe said a UHC healthcare system could be achieved by both the Government and private sector sticking to their current roles.

Recalling the BIA's NHI alternative, he added: "Our proposal ‎provides a framework for containing healthcare costs, affordable premiums through a price control mechanism and overall health insurance reform.

"Additionally, health insurers currently have clients across the length and breadth of the Bahamas; hence the issue of not providing service to all islands of the Bahamas does not arise."

Mr Komolafe said the Government finally responded to the BIA's proposal last Wednesday, with the industry also given "selective extracts and pages" from the Government's NHI implementation plan - but not the full workings.

He also confirmed that the Government and its Costa Rican consultant, Sanigest, had described themselves as comfortable with the figures for NHI's primary care phase - pegged at $100 million for the first full year.

This is despite the BIA having yet to provide its claims data, which accounts for 50 per cent of the Bahamas' total healthcare expenditure, to PricewaterhouseCoopers (PwC) so it can make the necessary projections.

"While we have serious concerns about the quality, relevance and appropriateness of the data that Sanigest has used to determine the cost of the primary care phase, and PwC maintains that it requires our data for proper costing of the primary care phase and vital benefits package, we have noted the NHI Secretariat's comments and position," Mr Komolafe said.

He expressed hope that the consolidated list of private sector NHI concerns, which will be presented to the Government this week, "will not be discarded but will be considered objectively".