The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Expanding the National Health Insurance (NHI) scheme to cover secondary care for select conditions "is not feasible at this time" due to COVID-19's fall-out, its governing body has confirmed.

The NHI Authority, in its 25-page consultation paper on transforming primary healthcare, said its ambitions to expand the scheme to "NHI 2.0" have been delayed - not abandoned - due to the pandemic's financial impact on the businesses and Public Treasury that will be required to finance the initiative.

It had originally been proposed that all Bahamian employers be "mandated" to provide health insurance cover for their employees, with the costs shared between company/worker via a payroll tax similar to how National Insurance Board (NIB) contributions presently work.

However, many businesses will be unable to absorb the extra financial burden this so-called employer mandate will impose due to the losses inflicted by the multiple lockdowns and other restrictions imposed by the Government to counter COVID-19, coupled with the tourism industry's closure.

"While there is substantial support from the Bahamian population for 'NHI 2.0', it requires the implementation of an employer mandate and additional funding by the Government. Given the economic and fiscal landscape, such an investment is not feasible at this time," the Authority acknowledged in a nod to the new realities.

"Additionally, the health system, particularly as it deals with COVID-19, lacks the foundation necessary to efficiently transition into this new environment. Therefore, the NHI Authority and the Government of The Bahamas have agreed that establishing the groundwork to enable the transition to NHI 2.0 and, eventually, universal health care, without any additional taxes or employer mandate should be the focus at this moment."

The so-called 'NHI 2.0' version is intended to expand the scheme's benefits such that it provides "comprehensive coverage for select conditions or treatments, all of which have a high prevalence in The Bahamas, including the most commonly diagnosed cancers, select cardiac procedures and end-stage kidney disease.

"The structure of the high-cost care programme would ensure that along with NHI-enrolled beneficiaries, those with private insurance will be covered if they have exceeded (to-be-determined) maximum mandated coverage for these conditions."

Dr Robin Roberts, the NHI Authority chairman, acknowledged in the position paper that it has had to rein in its ambitions - at least for the moment. "The journey towards universal health coverage (UHC) was not supposed to be easy," he added. "We have faced and overcome numerous challenges, all to ensure we prioritise a healthier Bahamian future given limited resources.

"However, the current reality of an economy impacted by the COVID-19 pandemic and a healthcare system which is operating beyond its capacity, and with minimal integration, has made it difficult to act immediately on some of the larger objectives of universal health coverage, such as coverage for high cost care."

The NHI Authority's paper said its proposal to transform primary healthcare in The Bahamas will effectively act as a bridge to 'NHI 2.0' by tackling the weaknesses and inefficiencies in the existing public system.

It argued that the duplication of primary care services offered by NHI, the Public Hospitals Authority (PHA) and Department of Public Health's clinic network had created a fragmented, non-aligned structure that duplicated resources and resulted in inefficiency and waste.

"There are barriers that exist in our healthcare system that need to be addressed in order to facilitate a successful and sustainable transition to NHI 2.0. Duplication within the public healthcare system means that both the NHI programme (which delivers services by partnering with private clinics) and the existing public clinic model are operating in parallel," the Authority said.

"This means that any transition to NHI 2.0 would become prohibitively costly without the integration of these two parallel systems..... Over the past decade, resources have been allocated to develop and implement various targeted primary healthcare programmes. While such actions are well-intentioned, this approach has been done in silos, and has led to the inefficient and costly delivery of primary healthcare services.

"Recent events like Hurricane Dorian and the COVID-19 pandemic have exposed the weaknesses of a fragmented health system that lacks co-ordination and appropriate protections for those who need it the most," the NHI Authority added.

"Our country needs robust digital infrastructure for healthcare delivery in addition to extensive screening programmes for non-communicable diseases (NCD) which are prevalent across our population.

"Our system needs to be designed and connected in a way that promotes continuity of care. An integrated care system must be adopted, and this feature is a core tenet of universal health coverage which supports efficient management of national healthcare spending."