The Tribune

THE much-vaunted National Health Insurance scheme – NHI – has hit another hurdle, it would seem.

In today’s Tribune Business section, we report that a series of new “caps and limits” are to be imposed on the benefits provided by the scheme.

It is not the first time that the realities of the costs involved in the scheme have run into the ambitions laid out for it.

Last year, for example, there was an extra 90-day wait added to enroll in the scheme. At the time, FNM chairman Dr Duane Sands warned that NHI was effectively “rationing the services” it provided to the Bahamian people.

NHI was part of the PLP’s ten-point plan when in opposition, listed in the party’s Blueprint for Change.

Under a banner reading “A Healthy Bahamas”, the manifesto pledged to “prioritise the health and wellness of our people, with NHI and affordable healthcare. We will implement sustainable national education programmes to fight lifestyle-related diseases”.

How much of any of that has come to fruition, you be the judge.

The latest move on NHI comes in a note sent by the government to healthcare providers – not, you will note, in any announcement to the users of the service.

The notice says there will be restrictions as part of “cost containment measures”, including restrictions to laboratory benefits to be introduced in October to “better manage… escalating costs”.

There will also be limits on the size of the NHI care network, the number of doctors, laboratories and other medical facilities enrolled in the scheme, with no new providers to be added on New Providence before the end of the fiscal year – that’s in June next year.

Payments for laboratory services will also be moved from the 15th of the month to the 30th – remember that next time the government is demanding prompt payment from those owing money to it – and that 90-day wait to join the scheme remains in place, except for expectant and new mothers.

The Health Minister, Dr Michael Darville, confirmed the notice was genuine but said it was “prudent” to “ensure the continued sustainability and effectiveness” of the scheme, while Dr Sands said of the costs: “I cannot see how they could not have put the brakes on this runaway train.”

The amount budgeted for the NHI Authority is $46.2m. Anyone who has had to deal with significant healthcare challenges will tell you how quickly the costs mount up. Elsewhere in today’s Tribune, you can read of one young boy who needs surgeries costing $300,000 in total – he is getting those out of the country but you can see the scale of the costs from just a single patient. Some medical cases soon reach a million plus.

The Budget that saw that $46.2m allocated was unveiled at the end of May. We are only into August and caps and limits are already being imposed. Was that not something, as one person speaking to Tribune Business noted, that should have been announced at the time? That person said: “Was the allocation insufficient? You cannot say that in the second month of the Budget. Why wasn’t that mentioned in the context of the Budget by the minister responsible for health?”

How our nation manages our health needs is a difficult challenge. There are many patients who suffer in silence because they cannot afford the treatment they need.

Solving that conundrum within our population and tax income is a difficult proposition for any government.

But NHI was the promise made to tackle such issues, and limiting access or cutting the services available is not delivering on that promise to anyone.

When schemes such as NHI are promised, our political leaders are to the fore taking the garlands. When it hits challenges, they should be just as up front – with solutions where possible, with reality come what may.

NHI has not yet lived up to those promises. And if it keeps having limits put on it, it will not do so any time soon.