The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Bahamian insurers yesterday warned that the Government's April-July 2019 target for launching National Health Insurance's (NHI) basic care package "is unrealistic and not feasible".

The Bahamas Insurance Association (BIA), unveiling its "position paper" on the revised NHI model, said there would be just three to five months to properly roll-out the scheme's Standard Health Benefit (SHB) once the 45-day public consultation was completed.

This timeline, it added, was more than two times' shorter than the health insurance industry's normal product development cycle, thus suggesting that the design of NHI's minimum benefits package is likely to be rushed.

"According to the [Government's] policy paper, the Standard Health Benefit (SHB) is scheduled to be launched between April and July of 2019," the BIA said. "It is our view that the proposed timeline is unrealistic and not feasible, bearing in mind that the 45-day consultation period ends on December 7, 2018 or December 26, 2018, if this is construed to be 45 working days.

"Once the consultation period ends, our understanding is that the feedback received from all stakeholders will be collated, reviewed and requisite amendments made to the policy paper before it is re-presented to the Government for approval. We presume that all things being equal, approval for the revised plan may be granted between December 2018 and January 2019.

"This leaves only three to five months for the design and roll out of the SHB by the NHI Authority. While this does not relate to the launch of the SHB by private health insurers, we recommend that the NHI Authority reconsiders the feasibility of this self-imposed timeframe."

The BIA continued: "It is imperative to note that from our experience as health insurers, the product development life cycle takes nine to 12 months provided there are no intervening unforeseen circumstances.

"We therefore propose that the launch of the SHB by private health insurers, which is scheduled for January 2020, be contingent upon the finalisation of the benefits package; costing of the SHB; agreement of a reasonable fee/reimbursement schedule with healthcare providers; and the conclusion of the consultation process with private health insurers.

"We submit that a realistic timeline for the launch of the SHB cannot be ascertained prior to the aforementioned milestones. This will separate the NHI Authority from the historical government trend of introducing grandiose plans within unrealistic timeframes and without full consideration of meaningful dialogue with key stakeholders."

Dr Duane Sands, minister of health, previously told Tribune Business that NHI's SHB package was estimated to cost around $100m, which the BIA noted represents a more than three-fold expansion of the Government's annual $30m allocation to the present scheme.

"It is the position of the BIA that the expansion of benefits under the NHI plan must be measured, calculated and pragmatic based on the fiscal challenges faced by the nation," the Association urged, echoing other private sector voices.

"In the wake of an increase in the Value Added Tax (VAT) rate, and in the midst of modest growth in the economy and persistent high unemployment, we advise the Government to proceed with caution. We recommend that the proposed schedule of benefits be adjusted to reflect the fiscal realities of the country."

Despite its concerns over what it described as "a number of fundamental issues" with the revised NHI model, the BIA welcomed the seemingly greater role for the private sector and efforts to involve it more in the scheme's design.

"The BIA supports the concept of universal health coverage (UHC) and shares the vision of the NHI Authority that residents of The Bahamas should not suffer financial hardship in gaining access to quality and affordable healthcare," it added.

"We believe that universal access to healthcare in The Bahamas is a noble and attainable goal in The Bahamas. We endorse the NHI Authority's philosophy of collective and shared responsibility while supporting the notion that NHI should care for those who need it most.

Still, the BIA queried whether the 3 percent premium tax and VAT will be levied on the employer/employee contributions that will finance NHI, describing this as one of many unanswered questions related to the scheme.