The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Family Guardian and its international partner, Aetna, were yesterday said to have emerged as the front-runners to land the contract to manage the National Health Insurance’s (NHI) public insurer.

Multiple healthcare and insurance industry sources, speaking on condition of anonymity, told Tribune Business that the BISX-listed insurer’s BahamaHealth subsidiary and Aetna were the leading contender to operate Bahama Care.

This newspaper was told that Family Guardian/BahamaHealth staff have been informed internally that the NHI public insurer contract will be awarded to them, although there has been no public confirmation to-date.

Lyrone Burrows, Family Guardian’s president, was yesterday said to be in meetings, and did not return Tribune Business calls seeking comment. Aetna, the US-based insurer with more than $60 billion in revenues, acts as the BISX listed firm’s international claims administrator and care co-ordinator when Bahamian policyholders travel for overseas treatment.

Aetna and Family Guardian’s likely role as joint Bahama Care managers emerged after it was revealed that the Government and its NHI Secretariat are prepared to launch the $100 million primary care phase without the private health insurance industry’s participation.

Under the scheme’s structure, private health insurance companies are supposed to act as Regulated Health Administrators (RHAs), working alongside Bahama Care to disburse monies received from the NHI Authority to pay doctors for services rendered.

However, Tribune Business contacts informed this newspaper that NHI project director, Dr Delon Brennen, told a meeting of Abaco healthcare industry stakeholders on March 30 that the Government was prepared to move forward without either the private insurers (RHAs) or Bahama Care being in place.

Dr Brennen has not returned Tribune Business e-mails seeking comment, but sources present at the meeting confirmed that he disclosed NHI was moving ahead without private insurance participation if necessary, and that the Government would pay doctors directly.

Yet the RHAs and Bahama Care are shown as playing a key role in the proposed NHI structure, sitting directly below its governing organisation, the NHI Authority, and providing compensation to doctors and insurance coverage to Bahamian participants.

Without the insurers, several sources have suggested there will be no claims adjudication oversight, potentially exposing NHI to both provider/patient fraud and corruption.

Emmanuel Komolafe, the Bahamas Insurance Association’s (BIA) chairman, confirmed to Tribune Business in a recent interview that private health insurance underwriters currently lack sufficient details to participate in NHI.

“The regulations have not been released, so the terms of reference for the Regulated Health Administrators (RHAs), we don’t have those. The discussions have not progressed to the point where it’s clear what the role of RHAs will be,” he said.

“It is what it is. Without those details, I don’t think we can engage at this time. We just don’t have the details to say why and how it works. If we don’t have the public insurer and private RHAs, you don’t have the intermediaries for administration of the whole system.

“They will be the interface. The private insurers have the systems already to adjudicate claims, they have the IT systems to adjudicate claims, tackle fraud and enable things to be efficient, ensuring service delivery is efficient and effective,” Mr Komolafe added.

“How will that work? It’s pushing that down the line. It’s very difficult for the insurance industry to understand what their role is.”

Mr Komolafe said the communication and information flow to the insurance industry, and other healthcare stakeholders, had dried up after the Universal HealthCare Stakeholder Advisory Council was disbanded.

All sectors were represented on this body, but the BIA chairman said they had been told its work was completed, and that it was to be disbanded to “pave the way” for the NHI Authority’s creation.

“The BIA is supposed to be represented on the NHI Authority’s Board,” Mr Komolafe added. “We’re not hearing anything pretty much, and communication out of the NHI Secretariat seems to have dropped off with the Council’s disbandment.”

The Christie administration is now in ‘a race to the finish’ to launch NHI’s $100 million primary care phase before the general election, even though key parts of the scheme’s governance and service delivery structure are not in place.

The NHI Secretariat yesterday announced that patient enrolment for NHI will begin on April 24, with Bahamians able to select their primary care doctor from the 60 private physicians, and public sector counterparts, that have signed up to provide services.