The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Minister of Health is confident the proposed National Health Insurance (NHI) scheme is “ready” for resubmission to the Cabinet, saying: “Most of the heavy lifting has been done.”

Dr Duane Sands told Tribune Business told Tribune Business it was more a “timing” issue of when the plan could be placed on Cabinet’s agenda for discussion, saying it would be “hopefully soon”.

Asked whether he was confident that initial concerns had been addressed, he replied: “Yes, I am. I think it’s ready; it’s just a matter of literally an acceptable time to get it on the agenda. Some of us are travelling and so on and so forth.

“Most of the heavy lifting has been done. Again, they’re [the NHI Authority] to be commended for then work they’ve done. The results of the the first report of the NHI Authority I believe say an awful lot.”

Almost $6m was paid to healthcare providers enrolled in the NHI programme from April 2017, its inception, to June 2018, the NHI Authority’s annual report revealed. Tabled in the House of Assembly last week, the report said there were 35,731 beneficiaries and 37 healthcare providers up to June 30, 2018, the end of the period covered by auditor Baker Tilly Gomez.

Up to December 13, 2018, NHIA officials said there were 45,821 people enrolled and 51 providers. Suggesting that much had been accomplished to reform the scheme under the Minnis administration, Dr Sands said: “If you recall we spoke about the then-NHI Secretariat operating without a budget.

“There were a number of questions about the legality, cost and so forth. It’s been legitimised, regularised and we’re up to 50,000 people benefiting from primary care services. We believe it’s been well-received, people are quite happy with the service they’re getting and we’re making an impact.

“The question is what will NHI 2019-2020 look like? Will we expand it? What added services or benefits will be made available to the people of The Bahamas, and at what cost? We have certainly made recommendations, and that is something for my colleagues and I to consider and take a position on.”

Dr Sands revealed to Tribune Business last month that the NHI Authority (NHIA) must “give it another go” after failing to win Cabinet approval for the scheme at the first try. He disclosed to this newspaper that the Government wanted answers to multiple questions raised during its first presentation to Cabinet on the reformed health care financing plan.

While not providing specifics on the queries raised by Cabinet, Dr Sands indicated there needed to be further testing of the “assumptions” that the NHI Authority has made to support how it has chosen to structure the scheme’s financing, operational and administrative mechanisms.

This was effectively confirmed by Graham Whitmarsh, the NHI Authority’s managing director, who subsequently told Tribune Business “we have work to do” to convince the government its “financing model” will not result in multi-million dollar shortfalls.

He said: “The final process is figuring out the financing of it and making sure we are able to fund it. That is what we are doing right now. “We have been working with the Ministry of Finance to explain our financing model to them. We have been making really good progress on that. We have done a lot of detailed work on the costing. We have been refining it continuously and will continue to do that.

“I see this as naturally part of the process. It’s welcomed because we all want to make sure that we have the best and most accurate numbers going into it. We have a very detailed cost model for NHI; for the cost of delivering services both to the beneficiaries of NHI and the cost of delivering it to those who have private health insurance through their employer.

“What we are doing now is starting to explain that to the Ministry of Finance in a lot more detail; how did we get those numbers; the assumptions used; the possible risks and variances; which numbers we are comfortable with and uncomfortable with.

“There is a huge amount of data we have worked through. I’m pleased that the Government wants clarity on this before they take a huge step on the way forward. I accept that we have work to do, but I think this a healthy process.”

One of the major queries raised by both healthcare providers and employers is how the NHI Authority has been able to price the scheme, and cost the SHB’s annual premium at $1,000 - split between employers and employees - when it has yet to agree a fee schedule with both doctors and medical facilities, the basic determinant of how much healthcare will cost.

The greatest fear raised by the Bahamas Chamber of Commerce and Employers Confederation (BCCEC) and others in the private sector is that if the NHI Authority gets its calculations wrong, and the $1,000 SHB premium severely undervalues the scheme’s price tag, businesses and their employees could be burdened with ever-increasing levies to finance its escalating costs and cover any shortfall.