The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

ALL Bahamas residents must "contribute" to the National Health Insurance (NHI) scheme's financing to ensure its sustainability, its chairman warned yesterday.

Dr Robin Roberts said the newly-appointed NHI Authority had effectively been given a 'blank canvas', and was starting all over again in designing a universal health coverage (UHC) plan that would meet Bahamians' needs without undermining the economy.

Addressing a Bahamas Insurance Brokers Association (BIBA) seminar, Dr Roberts said the Authority had yet to determine which benefits (healthcare services) would be covered by the plan; how much it would cost; and the timeline for when NHI would be fully rolled-out.

He added that if he was "whipping a horse" the revised NHI plan would be introduced in two years' time via a phased approach, but warned that the scheme would not be 'free' as the former Christie administration had suggested when it rushed the primary care phase's introduction prior to the May 10 general election.

Dr Roberts suggested several potential mechanisms for financing NHI, with payments linked to a person's ability to pay. Besides salary deductions (payroll tax) or an 'NHI Levy', the Authority's chairman said he wanted to create the Bahamian equivalent of the US Medicare scheme, which would provide a basic "safety net" for the likes of retirees, the poor/unemployed and indigent.

"Everyone must be involved, everyone must contribute," he told Tribune Business. "How much will this cost? We really don't know. If you look at the UK and Canada, they have income tax to fund their healthcare systems.

"We don't have an income tax, and I'm not saying we should. We will have to look at salary deductions in some fashion, or look at some other measures by which people contribute to NHI. What we also want to do is create a safety net which will be the equivalent of Medicare. That is the basic package of services everyone must purchase."

Dr Roberts said that while retirees would be expected to contribute to NHI, their payments would be less than a working middle class person drawing a salary.

The Christie administration sold NHI on the basis it would be 'free' and of no cost to the Bahamian people, repeatedly deferring questions on whether new or increased taxes would be necessary to finance it long-term.

The pre-election primary care roll-out was financed from Consolidated Fund, and the VAT revenues used by the previous government to finance social programme spending, but Dr Roberts yesterday made clear the Bahamian people needed to determine how much they are prepared to spend on healthcare.

He said the Christie administration "weren't sure" how to proceed with the two NHI phases designed to follow primary care, the introduction of catastrophic care and the scheme's comprehensive benefits package.

"How long will it take to have our comprehensive package of benefits? We don't know," Dr Roberts said of the NHI Authority. "What will they be? We don't know. We're a new Board and have to look at these challenges.

"We have to be open and make some very bold moves, and look at what we need for healthcare for our people. I'm going to suggest that we set our compass in line with where we're going to get the best healthcare package. We can offer to provide comprehensive services, but you will have to make a contribution to it.

"We need to pay for this. It's not going to be free. If we decide we're going to pay for it, it's going to have to come from salary deductions or direct payments to NIB. Whether we have an NHI levy, that's for the public to decide."

Dr Roberts said that ensuring NHI's sustainability was "the 800-pound gorilla in the room", given the ever-increasing costs of medical care and a Bahamian population afflicted by a high level of non-communicable diseases (NCDs) such as hypertension and diabetes.

"If you think healthcare is expensive now, wait until it's free," he told BIBA members, alluding to previously-expressed fears about how health utilisation rates would skyrocket as a result of Bahamians believing NHI was 'free'.

"The 800 pound gorilla in the room is sustainability. I can pay for it now, but can I pay for it next year?" Dr Roberts queried. "It's not how much it costs, how much I can afford. It's whether I can sustain it."

He pointed to data showing that US healthcare costs have increased by 880 per cent over the past 50 years, a growth rate six times' higher than that nation's GDP expansion and 30 times' higher than wage increases.

Dr Roberts said the Bahamas had experienced a similar trend, pointing out that while family medical insurance coverage cost him $60 in 1987, he and his wife were now paying $900.

"We're very cognisant of costs, very cognisant of the high level of non-communicable diseases," he added of the NHI Authority. "There's a tsunami coming down the road that I shudder to think how much healthcare is going to cost if we don't do something about it."

Dr Roberts said the Bahamas needed to move towards eventual implementation of an NHI comprehensive benefits package, and warned against becoming "sidetracked" by calls for a catastrophic health insurance scheme that would address life-threatening illnesses and prevent 'cook-outs'.

"When you look at the statistics we're a very sick country. I don't think catastrophic care is enough. There needs to be a comprehensive package," he added.

Dr Roberts said the NHI Authority had been given a mandate by Dr Duane Sands, minister of health, to ensure that the involvement of private doctors, providers and insurers was maximised under the NHI scheme.

He disclosed that he envisaged the private sector providing additional capacity and "equity" for Bahamian healthcare via public-private partnerships (PPPs), where patients accessed it for services unavailable in the public sector.

Suggesting that all parties would have to make concessions, Dr Roberts said greater input was needed from the Bahamian public on the healthcare model they wanted to see.

Arguing that there had been "too many consultations" already, and that the input of foreign consultants was not needed, he added that the Bahamas needed to devise a healthcare system that "is best for us".

"We need a healthcare system and models of care that is fit for the 21st century and the population as it is now," Dr Roberts said.