The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Despite the Government seemingly agreeing with two-thirds of its National Health Insurance (NHI) alternative, the Bahamas Insurance Association (BIA) has interpreted its scheme as making private health insurers “totally redundant”.

The BIA, in a July 27 letter to Marco Rolle, the Ministry of Health’s permanent secretary, said the Government’s apparent rejection of “three main pillars” in its proposal showed there was little appetite to discuss NHI alternatives.

The letter, written on the BIA’s behalf by co-ordinator Rhonda Chipman-Johnson, expressed fears that NHI amounted to “a complete nationalisation” of the private health insurance industry, and called for the Government to better structure is consultation process.

This was despite Mr Rolle, in a July 25 letter to the BIA, saying that the two sides held “a shared vision [on] the need and importance of universal access to healthcare in the Bahamas.

“With regard to the alternative proposals put forth, the Ministry is pleased to note that we are in full agreement with the majority of these,” Mr Rolle said, offering to arrange a meeting between the BIA and the Government’s NHI implementation team, plus its Costa Rican consultants, Sanigest Internacional.

Mr Rolle said the Ministry of Health disagreed with three elements of the BIA’s alternative proposal to achieve universal health coverage in the Bahamas.

While the BIA wants the estimated 50 per cent of the population with private health insurance to be able to keep their existing plans, the NHI scheme only envisages them being able to stay with the same underwriter.

“Their plans will be composed of the mandatory Vital Benefits Package and supplemental plans at their discretion,” Mr Rolle wrote of NHI’s intentions, a move that will seemingly deny existing private health insurance clients freedom of choice when it comes to plan design and benefits.

And, while the BIA had called for a ‘maximum premium’ or price cap to be set for NHI’s basic (Vital Benefits Package) plan, the Government wants there to be no premium paid for it under NHI.

“All funding sources will be collected at NHIC (National Health Insurance Commission), and a risk-adjusted rate applied to each member and transferred to the insurer of choice,” Mr Rolle wrote.

As for the BIA’s call that medical services fees be capped, Mr Rolle said all prices/costs would again be negotiated by the NHIC “so that the maximum purchasing price is utilised”.

This provoked a sharp reaction from the BIA, with Ms Chipman-Johnson writing two days later: “The BIA notes that the Ministry of Health does not support the underlying philosophy of our position, which is to ensure equity, choice, efficiency, effectiveness and maintain the role of the private sector as the primary driver of employment in the Bahamian economy.

“The disagreement on this fundamental principle makes the Ministry’s subsequent concurrence on some points in our proposal redundant and of no effect.”

Mr Chipman-Johnson said the Ministry of Health had only agreed on items contained in the 2006 NHI Act, and reports by its own consultants, and its disagreement with the three points in the BIA’s proposal “does not demonstrate good faith and shows your unwillingness to engage in any meaningful discussions”.

She added: “This only supports the notion that the Ministry endorses an approach that places full control of healthcare, health insurance as well as funds associated with them, in the hands of Government.

“This is a complete nationalisation of the private health insurance sector in the Bahamas. Your proposal makes private health insurers totally redundant.”

The BIA, Ms Chipman-Johnson said, was concerned “about the ineffective and inefficient framework” for consultation, asking whether the NHI Advisory Committee had been disbanded and replaced by something known as the NHI Elite Team.

And she questioned whether Mr Rolle’s July 25 letter was “merely sent to placate and obfuscate the already-confused state of the national discussion on universal healthcare in the Bahamas while your Ministry plows full speed ahead in the implementation of its agenda”.

The BIA letter drew a conciliatory response from Dr Glen Beneby, the Government’s chief medical officer, who said the sector’s acceptance of universal health coverage was “significant common ground”.

He added: “Let us continue to work together for the good of our country, with the obvious differences expressed at the beginning of this journey, but with the full appreciation that failure is not an option.

“The health of the nation is paramount to all of us. It is the equaliser and we must approach it in the manner with the respect it demands.”