The government has appointed a planning committee to formulate specifics as it relates to the promised National Health Insurance Scheme after signing off on all of the recommendations of a special commission appointed in 2002 to look into the feasibility of such a plan.
But while the committee is working aggressively to come up with the right formula for the scheme, it has not yet come up with a definite plan for how the National Health Insurance would be financed, Committee Chairman Dr. Perry Gomez said on Thursday.
Nevertheless, he indicated that the plan is no longer a matter of “if”, but “when”.
“The social health insurance levels the playing field in health,” he said in an interview with The Bahama Journal on Tuesday. “I believe that health is a right of individuals, not a gift; itﾴs not a privilege. All people are entitled to the best of health care that their countries can afford, regardless of the individualsﾴ ability to pay.
“Thatﾴs a problem we have in our country to a large extent. There is a discrepancy between the health care of the haves and those who have not and I think the best way of trying to address this issue is by finding some means of insuring the entire population and the best way to do that from all I have looked at and the Blue Ribbon Commission has studied is through this programme of social health insurance.”
Dr. Gomez indicated that the development of the scheme is “highly technical” and he indicated that one of the more difficult challenges faced by authorities is coming up with a cost structure for the plan.
Officials recently had a German consultant in town helping to address the costing issue. While noting that the cost factor is a difficult one to address, Dr. Gomez believes that it will eventually be worked out.
He said there are many benefits of a National Health Insurance Scheme.
“Payment at the point of service deters people from getting service,” Dr. Gomez said. “So you end up having people come in later with worse diseases and therefore costing your country more and so when people donﾴt have that barrier, itﾴs a tremendous advantage.”
But Dr. Gomez also pointed to a significant drawback of trying to get the scheme going.
“The major disadvantage to social health insurance [is that] it requires meticulous planning. It requires planning so yes people would say itﾴs taking long to come on board, but it has to take long because itﾴs important to do it right the first time,” he said.
The report of the Commission, presented to the government last year, recommended that National Health Insurance should be universal.
“In order to achieve universal coverage, all population groups should be identified,” it said. “The institution administering the NHI system will decide which individuals or households in each group are able to pay contributions and which will need assistance from the government.”
It noted also that people who do not have the ability to pay and who lack private health insurance with appropriate coverage cannot access secondary or tertiary care services if they are not available in the public health care system.
In addition, the Commissionﾴs report noted that, “Due to the relative prosperity of Bahamians, the lack of any direct form of taxation, and the fact that a significant portion of the population already pays some form of private health insurance, there appears to be an existing capacity for the introduction of a NHI system that would be funded by residents of The Bahamas, employers, and the government.
“Notwithstanding this, economic disparities do exist and a percentage of the population (the indigent and the unemployed) would need to be subsidized by the government. For the most part, this population now receives government assistance,” the report said.
On Tuesday, Dr. Gomez noted that the government is spending about $150 million annually on health services and collects only about $4 million.
“We hope the cost to the government [with the NIH] would be less than itﾴs costing now,” he said. “Some experts believe that if itﾴs going to cost the government more than [the $150 million it is already paying] then this scheme does not make sense.”
Authorities have established an office at the National Insurance Board where members from the project development team are working.
Because of the time-consuming task of planning the scheme, Dr. Gomez said that realistically, it would be another two years before it becomes a reality.
Candia Dames, The Bahama Journal
