The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Chamber of Commerce's chairman yesterday queried if Bahamian workers will suffer reduced healthcare quality given the revised NHI scheme's "maximum" premium contribution.

Michael Maura, pictured, in an emailed reply to Tribune Business from New York, said the top-end $42 monthly premium contribution to be paid under the new National Health Insurance (NHI) model "causes one to question" whether the standard of healthcare would be less.

"Many employers providing quality health care cover to their employees today do so under a shared contribution plan," he explained. "The maximum $42 monthly premium (described in the draft document) to be paid by the employee causes one to question whether the quality of the proposed care may be less and/or the employer may be expected to contribute 90 per cent of the total premium."

Mr Maura said the Chamber was waiting until its Monday, October 29 meeting with the NHI Authority, the scheme's regulator, before providing a detailed response to the restructuring. In the meantime, the private sector organisation also plans to consult fully with its members.

"The [Chamber] acknowledges the desire to provide affordable and quality health cover to the residents of The Bahamas," Mr Maura added. "Furthermore, we share the understanding that this objective is a very complex one, requiring the active engagement and buy in of all stakeholders.

"The NHI Authority has been meeting with stakeholders, and they must continue to do so until such time that all stakeholders agree that the final plan is acceptable, and to include the funding plan and quality of care provided to both those with existing health cover and those presently without.

"Additionally, it is paramount that all those expected to underwrite any new national health plan must also buy in. The Chamber looks forward to productive and meaningful dialogue with all stakeholders over the coming weeks, and will provide a formal position on the NHI programme within the allotted 45-day period."

The revised NHI model unveiled yesterday appears to have embraced a number of recommendations from the private sector, including calls for a greater role for private insurance companies.

While private insurance companies will be responsible for issuing and "selling" NHI's basic coverage package, the Standard Health Benefit (SHB), under the new structure, this will be price-controlled and subject to terms/conditions imposed by the NHI Authority.

It also appears that Bahamian businesses and individuals will be unable to retain their existing coverage and policies, as insurers will have to "restructure existing plans" upon their first renewal after January 1, 2021, "to include the Standard Health Benefit" package. Insurance companies will be allowed to offer "top-up" policies to the SHB, though.

Dr Duane Sands, minister of health, yesterday told Tribune Business that insurance companies will have to compete on non-price factors under the new NHI model. He indicated that the health insurance sector would likely shift to a volume-driven, rather than margin-based, business as NHI would give it access to a wider pool of 380,000 potential clients.

"It gives people some choice, but also strengthens the private sector," the Minister argued. "It opens up competition. If company 'A' is more efficient on service than company 'B' it may find it has a significantly larger market share.

"They may find their product is more attractive because of service provided and turnaround time for the approval of payments to laboratories and diagnostics. What I anticipate is we create a market that allows for competition in the market even though the cost of the product is the same.

"I suspect it will have an interesting impact on the willingness of the insurance companies to provide better service. You have the potential for 380,000 people; an unlimited market."

Under the NHI scheme's proposed contribution rates, if a person earns $5,000 each year, a salary deduction of $8 per month will go into the NHI funding pool. Those with an income of $10,000 will pay $17 every month, and a person that takes home $15,000 every year will contribute $25 per month.

Those earning $20,000 each year are expected to pay $33 each month, while those earning the national median income of $25,000 a year or above will pay $42 per month. The Government aims to have "mandated private health insurance for employed persons, bringing the total population privately insured to approximately 55 percent by 2022".

Self-employed persons will have to pay 100 percent of their SHB premium, which is pegged at $1,000 per year or $83 per month. Yet there are several categories that will be "exempt" from the first phase of the employer/employee contributions, which will start in January 2020 for businesses with over 100 employees.

Among those exempt are persons employed by a company with has less than 100 full-time total employees; part-time employees working less than 15 hours per week; employees who work multiple eligible jobs (15-plus hours) who currently hold mandated minimum health insurance from another employer; grandfathered insurance plans; and businesses with annual revenues of less than $100,000 per year.