The Tribune

By NATARIO McKENZIE

Tribune Business Reporter

nmckenzie@tribunemedia.net

THE Bahamian heath care system "lacks equity", the National Health Insurance Authority's (NHIA) chairman lamented yesterday, arguing that the revised scheme will prevent patients "falling through the cracks".

Dr Robin Roberts said: "What we have designed is that no one will be excluded on the basis of their current illness or charged more. We are all sharing in this cost. One of the major problems in our health care system is we lack equity. Those who need care can't get it, and those who need more care can get anything. They just don't have the money."

The NHI Authority's 21-page policy document, released yesterday, noted that about eight percent of Bahamian GDP is being spent on healthcare, but "the Bahamian population is not seeing many of the much-needed benefits from this expenditure" .

"Despite the investments made, the previously stated problems of an uninsured and unhealthy population are leading to an inefficient and expensive system with poor health outcomes," it added, setting out the rationale for NHI.

"There are complicated factors in the Bahamian healthcare system that make change hard to achieve. Long wait times due to increasing demand for public sector health services have put significant strain on a system with limited resources. This places a great burden on our healthcare workforce to find capacity where there is none."

The NHI paper said it had become easy for patients to "fall through the cracks, and fail to access the services that they desperately need".

"The nature of the archipelago also makes delivery of healthcare services expensive. Historically, ineffective use of resources has made The Bahamas one of the least efficient nations in the world when it comes to value-based care," it added.

"Furthermore, without digital health records and interconnected end-to-end service delivery, the cracks that people fall through will continue to widen. NHI plays a key role for the ten percent of the population it currently provides coverage to, serving as an important first step in bringing people into the health system that they would otherwise have difficulty accessing."

The revised NHI model proposes to have a standard health benefit (SHB) as base coverage. "NHI will work with the private health insurance companies to provide cost effective supplemental coverage for the elderly population," the consultation paper added.

"Coverage under this plan may include private services at public hospitals, private providers and overseas care. Eligibility for this coverage will be for those eligible for NHI coverage as detailed below, who are also over the age of 65. Unlike NHI base coverage, the supplemental coverage will come with an additional premium cost paid by the beneficiaries themselves, and this premium will be affordable, significantly less costly than any alternative.

"The legislative requirement will be for employed individuals and their employers to purchase the SHB from private licensed insurance companies in The Bahamas, and this will cause a significant increase in the number of individuals in private insurance plans, and corresponding increase in the health insurance marketplace," the paper continued.

Under the revised NHI model, "risk equalisation" will help to keep premiums affordable. "Since premium prices for the SHB will be regulated to support health insurance affordability and accessibility, reimbursements to insurers are necessary to incentivise coverage of high-risk individuals," it explained.

"The system works by establishing a common pool of resources, collected through contributions as a portion of collected premiums from both the public payer and private insurers.

"This pool is then divided among insurance providers, including NHI as a payer, based on their risk profile. At the onset of the employer mandate, 50 per cent of the SHB premium would be considered 'at-risk' and used to form a risk equalisation fund that would then be re-distributed to insurers based on the relative risk of their entire beneficiary pool.