The Tribune

• But only 61% of public directly enrolled

• Relies on private insurers to cover rest

• Sector’s early fears ‘sufficiently satisfied’

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The National Health Insurance (NHI) scheme is targeting a rapid expansion that aims to provide “more than 90 percent” of Bahamians with its basic primary care coverage by 2025.

The plan’s governing authority, in a just-released report on the public’s response to its primary care goals, said widely increased coverage relies on significant buy-in by both private health insurers and physicians to help achieve this objective.

While the NHI Authority is forecasting that 61 percent of Bahamians will be directly enrolled with the scheme within the next four years, its standard health benefit (SHB) - the base level of primary coverage - will reach over 90 percent of the population via private health insurers.

The report reveals that the likes of Colina Insurance Company, Family Guardian and CG Atlantic Medical & Life will be mandated to offer NHI’s SHB as part of existing and new policies, meaning their clients will not have to register as NHI beneficiaries despite being able to access the same coverage.

It was not disclosed how this requirement will be mandated and/or enforced, although presumably it will have to be given legislative effect via and Act of Parliament. And expanding the number of private doctors and physicians providing treatment to NHI beneficiaries was cited as key to improving patient outcomes and experiences, as well as expanding services throughout The Bahamas.

“The primary care transformation initiative (PCTI) is on track to increase primary care coverage in The Bahamas. By 2025, 61 percent of Bahamians are projected to be enrolled in NHI with more than 90 percent having access to SHB coverage,” the NHI Authority report asserted.

No data or analytical models were provided to support these projections, and one healthcare industry source - speaking to Tribune Business on condition of anonymity - said the absence of empirical evidence to support forecasts had been a consistent gap with the NHI scheme.

“Everything they have in that document is what they project will happen,” the source said. “There is no statistical evidence for the hypothesis: This is what we want to happen, this is how we do it, how much it will cost.

“This is the theory behind it. From inception NHI has been very theoretical from book knowledge and predictions, but very little is hard facts as to what they’re doing so they can continue to provide cost effective, sustainable healthcare for The Bahamas. There’s no one knocking down the doors to join.”

They added that, to achieve its 2025 breadth of coverage objectives, the NHI Authority was “hedging its bets on the insurance industry coming on board to provide NHI benefits to beneficiaries, and to be their representatives through an NHI partnership. They are also depending on private physicians to align with NHI to expand then provider platform”.

It appears that the Bahamian health insurance industry may have little choice but to comply with the quest for what is billed as “universal access to affordable healthcare” for Bahamians. The NHI Authority’s latest report acknowledges that its plans mean changes for private insurers and both their individual and group (employer) clients.

“Individuals who have coverage through private insurance will no longer be eligible to access primary care coverage from NHI. Instead, they will be able to access SHB coverage through their private policy,” the NHI Authority affirmed.

“Private insurers will be required to mirror SHB as the minimum standard of coverage for primary care. This means that existing private insurance plans will be strengthened, while requiring no co-payments or deductibles for SHB services and offering an improved patient experience through the electronic health record. Individuals who are privately insured will not need to enroll in the NHI programme.

“In addition to the SHB, policyholders will continue to enjoy any existing coverage that they have previously negotiated with their private insurers and/or employers. The reforms under the PCTI will also provide greater cost certainty for insurers and should provide for more predictable and affordable policies.”

Sandy Morley, the Bahamas Insurance Association’s (BIA) vice-chairman, yesterday told Tribune Business that the health insurance industry’s initial concerns over the SHB proposal and NHI’s wider implications for the sector have been “satisfied” following discussions with the Authority.

“We’ve had extensive dialogue,” he said. “There have been discussions, and there’s a working group that NHI has put in place which includes the Bahamas Insurance Association. There were some initial concerns but we were able to work through them sufficiently and the industry is satisfied with how it’s going to work.

“The only aspect that impacts us is the aspect of primary care. It’s not going to impact the additional health benefits for any of our customers. We’ve always had the standard benefit. What this does is carve out who should be registered with NHI and who shouldn’t be.”

The NHI Authority’s latest report reiterated its belief that the public healthcare system, and Bahamian taxpayers, could enjoy a total $55m in savings spread over the next five fiscal years by better integrating the existing primary care facilities (clinics) with treatments provided by NHI.

“We envision part of these savings to be reinvested into the system to update and upgrade some public healthcare facilities. Engaging the private sector through public-private partnership (PPP) models will also bring in much-needed investment to enable us to deliver improvements without the burden of financing capital on the public sector,” the report added.

“Recognising we are in the midst of difficult financial times for Bahamians, the NHI Authority is committed to the journey towards affordable healthcare and universal health coverage. We are seeking to remove financial barriers like co-pays and deductibles in accessing healthcare.”

The NHI Authority had previously estimated that it could trim the Government’s annual primary healthcare system by $16m per annum come the 2024-2025 fiscal year, lowering the total from $130m under the present structure to around $113m. This would involve NHI accounting for the bulk of such spending, some $91m, while virtually eliminating the Public Hospitals Authority’s (PHA) contribution in this area.

However, the economic devastation inflicted by the COVID-19 pandemic has imposed some limits on what the NHI Authority can ask taxpayers to fund. For the foreseeable future it is focusing in primary care only, having been forced to pause a planned expansion to include catastrophic care benefits.

“The NHI 2.0 proposal included expanded benefits to deliver more comprehensive coverage for high-cost care, a mandate for employers to provide insurance and a national risk pool to enable affordability and access,” the NHI Authority said.

“In a post-COVID-19 landscape where our economy has recovered, and when the time is right, we will strive to expand coverage and implement other reforms initially envisioned as part of NHI 2.0. For now, we recognise the need to balance our healthcare priorities while considering the challenges our businesses and economy face.”