National Health Insurance: “Facts and Friction” not

(Dr. Marcus Bethel MD, former Minister of Health, 2002-2006, has released a statement on an item of great national interest, National Health Insurance. We publish the communication as follows, in its entirety):

“National Health Insurance (NHI) is defined as health insurance coverage for the population of a country so that access to affordable quality health care is assured for all, regardless of social or economic status and pre-existing health conditions.

NHI package is custom designed for each country, depending on affordability and sustainability, “one size does not fit all”

In The Bahamas, formal consideration of NHI was initiated in 1983 when a Blue Ribbon Commission was appointed to research same.

The report was completed in 1987 and concluded that the cost was prohibitive for implementation of a comprehensive scheme.

During the 1990s the Government of the Bahamas (GOB) promoted the introduction of a “Catastrophic Health Plan” which did not materialize.

In August 2002, the GOB appointed a second Blue Ribbon Commission to formulate a “Comprehensive National Health Insurance Plan.”

The conclusion of this Commission was that a comprehensive health care program was too costly and recommended a phased development program with the initial introduction of “Comprehensive Primary Care” which was introduced nationally in April 2017 and has 40,000 registrants to date.

 This primary care program has subsequently been revamped by the current GOB to include expanded primary care services and selected catastrophic care coverage.

This new package has a projected 2 percent payroll attached and is referred to as the “Employee Mandate”

The selected catastrophic care coverage is confined to Cancers, Cardiovascular Diseases and Chronic Renal Diseases.

I do not think that this revised package has been subjected to adequate  and transparent cost analysis.

The current functioning primary care package has not been adequately cost analysed because there has been insufficient time and experience with only one tenth (1/10) of the population enrolled.

Adequate Funding of

NHI is fundamental

to its sustainability.

Detailed cost analyses including actuarial studies are absolutely necessary before expanding and implementing any new benefits to a basic NHI program.

There exists urgent needs to upgrade hospitals and clinics both physically and operationally, resolving physician and nursing concerns, staffing of family island health care facilities, addressing concerns of the general population, Insurance companies and Businesses.

Public health facilities, particularly hospitals, would be required to bear the burden of managing catastrophic care clients and must be able to perform the functions mandated.

These are fundamental steps required to gain the necessary buy-in by stakeholders without which sustainability is compromised.

The economic impact of a 2 percent payroll tax would be an unacceptable burden in our developing country which is struggling with a depressed economy and high unemployment and could potentially push the country into a recession.


1. This revised package of benefits being promoted ought to be delayed and phased in when economically sustainable.

2. The basic primary care package should be given the opportunity to fully develop with maximum enrolment to provide a track record for appropriate cost analysis before consideration of expanded benefits.

3.  GOB should use available funds to upgrade all public health facilities to acceptable standards to sustain benefits, resolve outstanding issues with physicians and nurses and other health care professionals.

4. Public Health Authority (PHA) must develop appropriate billing and accounts management at health care facilities to improve cash flow and reduce deficits.

5. GOB must eliminate free service at public facilities for public officers/servants who possess adequate health insurance.

6. GOB must bring greater transparency to the costing of “employee mandate” contained in new package before implementation.

Conclusion: “GOB must not bite off more than the public can chew.”

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