The Tribune

WITH the implementation of National Health Insurance only 10 months away, the proposed health scheme is still drifting around in clouds of indecision.

The final report outlining the benefits and suggesting schemes for financing, was presented to the Ministry of Health and the National Insurance Board, by the government’s advisers — Sanigest International – on October 2 last year. It was marked: “Confidential: Not for distribution.”

Although January 2016 was announced as the date of implementation, Prime Minister Christie said recently that government has not yet decided on how to cover the cost because it was still receiving advice on how to develop the scheme.

If this statement is true, and Sanigest’s outline of what has to be done to meet government’s proposed implementation date, then Bahamians can forget January 2016. Unless, of course, this insurance will be bungled to the finish line, and end up drowning all of us in debt.

The Sanigest report says that “in light of the myriad of factors to consider in moving forward with National Health Insurance (NHI) implementation, there are seven key milestones that need to be met in the lead up” to the January 2016 launch date.

It summarises these milestones and includes tentative deadlines for each.

“These deadlines,” said the report, “should be viewed as the latest date by which decisions and modifications should be made.

“The first two milestones relate to key decision points on financing and administrating NHI, the BP, the overall public health system structure, including defining legislative changes. Without decisions on these key areas NHI implementation cannot progress, therefore it is critical that all decisions are made by November 2014.”

November 2014 was four months ago — and the debate goes on with final decisions yet to be made.

Note, that what is now being discussed, is still in the advisory stages with the Prime Minister taking advice from English and Canadian consultants on the best way to implement the plan.

The Sanigest report goes on to say that by January this year — that’s two months ago – “there needs to be decisions on the IT vendor and system requirements for NHI and Private Health Insurance/DPH.

“IT implementation,” it continued, “needs to occur immediately following this. By the beginning of February“ – that’s last month – “decisions on the movement forward on the public health system with regards to regionalisation, governance, and other factors should have been concluded. By March 2015” – that’s this month — “provider payment mechanisms need to be finalised so that contract discussions can begin with potential providers. Any modifications to NHI and related legislations in line with the collection and use of funds, participation of private insurers and regulation of NHI rates, packages, payments mechanisms need to be formalised by May 2015” — that’s in two months time. “Enrolment of beneficiaries, fund, holders and PCP selection must be fully operationalised by October 2015. Finally all IT systems and other enabling factors need to be in place by November 2015.”

Sanigest also recommended considering consolidating the functions of the Bahamas National Drug Agency and the Material Management Directorate.

What still has to be completed before a launch date can be discussed is mind-boggling. At the pace at which the discussions are now moving, January, 2016 is obviously an unreasonable date for which to aim.

FNM leader Dr Hubert Minnis said that while he agrees with NHI and believes every Bahamian should have access to health care, he thinks the way government is going about it would give the Bahamian people “hell”.

In his opinion, another tax on top of the recently implemented VAT would “cripple the middle class and kill the poor”.

And then there is the acknowledgment by Health Minister Dr Perry Gomez who recognises that NHI is a “contributory scheme and the level of employment is very important because the more unemployed there are then the greater burden on the government to finance it”.

Dr Gomez said that when the report was done more than ten years ago in the first Christie government, unemployment was just under eight per cent. However, he continued, when the PLP were returned to office in 2012, “the unemployment rate was 15 per cent, hence the reservation in going forward at the time”.

However, said Dr Gomez, he thinks that January 2016 is a feasible date and that “the state of the economy would be much better. It’s already improving.”

How Dr Gomez could make that statement is anybody’s guess. Not only is the economy not improving, but it is getting worse — with only Baha Mar in sight as a possible bail out. However, with the disagreement now going on between Deputy Prime Minister “Brave” Davis and the Izmirlians over what government is expected to pay towards the West Bay Street road improvements, even that doesn’t look very promising.

Dr Gomez said that when the PLP came to office in 2012, the unemployment figure was 15 per cent. However, by November 2014 unemployment, according to the latest survey, was 15.7 per cent.

The Department of Statistics reported an increase in unemployment in both New Providence and Grand Bahama between October 27 and November, 2014. In New Providence unemployment went from 14.7 per cent to 18.6 per cent. As for Abaco, the unemployment figure was 20.3 per cent.

During a press conference at the Department of Statistics, the statistician said that although there was an “increase in both the number of employed and unemployed persons; the growth in the number of unemployed persons exceeded that of the employed.”

If Dr Gomez had reservations in 2012 about going ahead with NHI with an unemployment rate of 15 per cent, what gives him such confidence now to press the green light for January 2016 when the unemployment figures for New Providence and Grand Bahama are 18.6 per cent and 20.3 per cent for Abaco?

Such an assessment by persons who are in charge of putting such a heavy burden on the Bahamian people certainly does not inspire confidence.