The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

QUESTIONING the “government’s commitment to consultation and transparency,” United Healthcare Reform Alliance, a coalition of medical and insurance stakeholder groups, claimed yesterday that it was “blindsided” by the government’s tabling of its landmark National Health Insurance Bill in the House of Assembly on Wednesday.

Health Minister Dr Perry Gomez had said on Wednesday that the NHI Secretariat engaged all relevant stakeholder groups, seeking their input and comments on the bill.

“As a result, this NHIA Bill which is now being presented to the Parliament is a fully informed Bill,” he said.

However, the United Healthcare Reform Alliance (UHRA) appeared to disagree with this characterisation of its role in the process.

While numerous stakeholder groups were indeed consulted, UHRA suggested the consultation was insufficient.

In a statement, the group said the feedback stakeholders gave to the NHI Secretariat was compiled in a report that was released “a mere 17 hours before the landmark legislation was presented in Parliament.”

“The move is a latest in a very one sided process,” UHRA said. “The government has a fixed idea of what it wishes to achieve and will not recognize the flaws in the legislation which are obvious to everybody but themselves.

“The process moves ahead without proper checks and balances, prudent adherence to counsel offered by qualified local and international healthcare experts, a sound plan for funding the programme, and regulations to ensure proper interpretations of the Bill.

“The revised Bill as made available on the NHI Secretariat website hours after it was tabled and the NHI policy has still not been formally shared with stakeholder groups. It is, therefore, possible that the draft legislation still retains technical flaws which, if adopted, would place our country’s ability to provide quality healthcare to its citizens and residents in greater jeopardy.

“Stakeholders are also now more acutely aware that the government intends that the UHCSAC to act only as a rubber stamp. It is becoming clear that the government has no intention of engaging in a true partnership for the delivery of healthcare to the Bahamas.”

The frustration of stakeholder groups over the way the government has pursued NHI has been a persistent feature of the project even though the secretariat has made efforts to address their concerns.

The NHI Advisory Council was formed in June by the NHI Secretariat, for instance, to aid the secretariat as it seeks to implement NHI and to assuage concerns that stakeholders were being left out of the process.  

That council group involves more than a dozen stakeholder groups from UHRA that mainly represent insurance companies and medical professionals.

The problem may be that while the secretariat has made strides in enhancing its engagement with stakeholders, it doesn’t have a central role in making the decision on certain key concerns of stakeholder groups since many such issues are decided at the cabinet level.

This was underscored by a chart the secretariat published featuring the feedback of stakeholders on the original NHI draft bill and the response of the secretariat.

In response to some of the stakeholders’ concerns, the secretariat said the matters were a “policy decision,” meaning they could only be addressed by Cabinet.

One of the chief concerns stakeholders have is that the minister responsible for NHI––a still unidentified individual––will have too much power to influence the affairs of National Health Insurance Authority (NHIA).

With respect to the original NHI draft bill, the government’s lead consultant, KPMG, shared this view.

“The (NHIA) is structured like a traditional government corporation and does not offer any modern transparency measures,” KPMG said about the original bill. “The structure allows for heavy political control, with board appointments, staffing decisions, and other key decisions being ultimately at the direction of the minister. This will create immediate distrust with providers, insurance companies and administers and that the entity will be politically managed. Powers of the minister should be largely removed, except as relates to the establishment of the national healthcare policy with the input of the NHIA.”

The Tribune’s review of the newly tabled bill shows that the powers of the minister have been curtailed in some areas but not all.

One key area of change relates to audits.

Whereas the original bill mandated that an independent auditor be hired by the Authority to conduct annual audits on the approval of the minister, the newly tabled bill does not mandate that the minister have a say in determining who the board selects to be its independent auditor.

In fact, compared to the original bill, the newly tabled bill puts greater demands on the Authority to be transparent and accountable in the pursuit of its objectives.

Nonetheless, in some other key areas, the minister’s power remains intact compared to the original bill.

For instance, against the wishes of stakeholders and the government’s KPMG consultants, the bill gives the minister responsible for NHI the power to approve investments without ensuring that it necessarily subscribes to a policy established by the Board.

The bill also grants the minister apparently unilateral power to create regulations for numerous key issues, like the rate and mode of payment of contributions by beneficiaries and employers that are part of the plan, something some fear could become subjected to the political whims of politicians.

Damara Dillet, a legal representative for the NHI Secretariat, defended the role of the minister in the NHIA framework, noting that in the Westminster system responsibility for important matters ultimately lies with the minister.

Wednesday’s tabled bill is a landmark moment in the process of realizing one of the Christie Administration’s highest priorities.

However, key issues relating to the NHI scheme will remain unknown until regulations are established.

For instance, regulations will specify the procedure to follow for people looking to enrol in the scheme and to select administrators and primary care providers.

Regulations will specify applicable benefits for different groups of people as well as the “rate and mode for the payment of contributions by beneficiaries and employers.”

Regulations will also prescribe the procedure for resolving grievances.

Peter Deveaux-Isaacs, Permanent Secretary for the NHI Secretariat, told The Tribune yesterday that he expects the regulations to be completed by the first week of September.