The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The private sector yesterday described the April 1 target date for National Health Insurance’s (NHI) roll-out as “impossible, impractical and unreasonable”, the Chamber’s chief executive adding: “It will not happen.”

Edison Sumner told Tribune Business that unless the Government was “moving behind the scenes at the speed of light”, the planned April 1 launch of NHI’s primary care phase was unattainable given the amount of work that remains outstanding.

While the Government and its NHI Secretariat have yet to officially confirm any launch push back, Mr Sumner confirmed that the insurance industry and Bahamas Chamber of Commerce and Employers Confederation (BCCEC) share similar concerns over the scheme’s draft legislation.

In particular, Mr Sumner said the draft NHI Bill - and all future Bahamian legislation - needed to move away from a structure that gave “absolute power” to the responsible Minister.

Those concerns were echoed by the Bahamas Insurance Association (BIA), which in a statement yesterday said the Minister responsible for NHI is currently being granted “expansive powers” with no checks and balances.

Mr Sumner, meanwhile, when asked by Tribune Business whether he thought NHI’s April 1 implementation feasible, responded: “Impossible, impractical and unreasonable.

“It will not happen for April 1, unless something is happening behind the scenes that we’re not aware of, and that something has moved this programme forward at light speed.

“The programme’s launch on April 1 is impossible, impractical and unreasonable. It will not happen.”

The Chamber chief added: “Realistically, given where we are with the legislation, where we are with the preparations for the primary care roll-out, to launch by April 1..... that date is thrown out the window.

“Looking at it from the private sector side, no way will that happen by the 1st of April or the end of April.” Mr Sumner said it was now incumbent on the Government and its NHI Secretariat to confirm that.

With the NHI Bill yet to make it to the House of Assembly, consultations still ongoing, medical industry stakeholders yet to buy in, and many vital details surrounding the scheme either unknown or yet to be resolved, including its cost and how it will be funded, the primary care launch date appears almost certain to be pushed back from April 1.

Mr Sumner said the wider private sector shared similar concerns to the insurance industry over the NHI Bill, with the BCCEC preparing to release its recommendations and critique later this week.

“I’m sure many of those concerns will resonate with the insurance industry as well,” he told Tribune Business. “One of those concerns relates to the level of power of the Minister.

“We will be providing our own response to the legislation in the next couple of days, and express concerns about the level of power vested in the minister, particularly when it comes to their ability to appoint and hire certain individuals in the [NHI] Authority.

“We will also raise concerns about the powers of the Minister to appoint virtually all the Board members of the NHI Authority,” Mr Sumner continued.

“We shall be making recommendations as to how to correct that in the legislation as well as practically. We’ve got corporate governance concerns, and concerns over other aspects of the legislation that we will be publishing shortly.”

The BIA, in its release, warned that the draft Bill as is “creates significant opportunity for political interference” over the NHI Authority, the scheme’s governing body, given the Minister’s ability to ‘hire and fire’ executives and Board members.

The insurance industry, in particular, expressed concern over the NHI Bill’s Clause 9, in which the Minister is empowered to “give to the [NHI] Authority such directions of a general or specific character regarding the discharge of the functions of the Authority”.

And Clause 4 (5) provides the Minister with “unfettered rights” to amend the constitution and procedures of the NHI Board.

Tina Cambridge, a former BIA chair and member of the BIA NHI Committee, was quoted as saying the Bill “creates significant opportunity for political interference, removing the autonomy, independence and objectivity in the running of the NHI Authority, and reduces Board members to agents of the Minister, who then becomes a law unto himself”.

While decrying the NHI Authority’s seeming lack of autonomy and independence from the Government, the BIA said the Bill also allowed the Minister to hire or fire its legal officer and medical officer.

Mr Cambridge added that Clause 43 (1) appeared to allow the Minister, without the consent of Parliament, to make regulations, including a regulation to dictate which categories of persons would be exempt from NHI contributions, co-payments or other cost-sharing obligations.

Warning that this could open NHI to abuse, and arbitrary influence, she added: “Changing who pays contribution or co-payments could have material financial implications, and the Minister should not have the unilateral ability to do this.”

The BIA said the Bill also seemingly goes against corporate governance best practices in identifying the composition of the Board, which, according to its proposed Constitution, is currently set to include 12 persons.

Seven of these are to be appointed by the Minister, who is supposed to select representatives of the NHI beneficiaries, the medical and nursing professions, and the religious, commercial and labour sectors.

Lyrone Burrows, the BIA’s deputy chairman, said the insurance industry is “notably absent” from this list.

He added that the proposed corporate structure was “highly deficient and opens the flood gates for political interference, cronyism, nepotism, conflicts of interest and political patronage”.

The ex-officio, non-voting Board members, are proposed as the directors of the NHI Authority, the National Insurance Board (NIB) and Social Services, plus the Superintendent of the Insurance Commission and the chief medical officer.

Mr Burrows said these were all civil servants or government employees, and suggested this gave the Minister too much power over the governance of the NHI Authority and composition of the Board.

The BIA’s views were backed by Mr Sumner, who told Tribune Business: “We want to move away from this structure of absolute power.

“Right now, the way the legislation reads, it gives the Minister absolute power. No one is going to support that kind of provision in the legislation.”

Calling for amendments, Mr Sumner said a ‘spreading out’ of the Minister’s powers between other persons would benefit both NHI and the process, and foster greater “transparency and accountability”.

“If we’re able to share the Minister’s responsibilities with others, we will have broad-based accountability on the issues,” he told Tribune Business.

“It removes the risk or temptation to have political interference in the appointment and dismissal of persons working at an executive level in the Authority.”