NHIA Chairman explains programme, residents express concerns

DR. ROBIN ROBERTS, National Health Insurance Authority (NHIA), Chairman

Members of the public and stakeholders of the National Health Insurance Authority (NHIA) engaged in a discussion at the Eric L. Sam Auditorium, Church of the Ascension Tuesday (November 6) evening, to discuss the proposed National Health Insurance Programme.

Similar discussions took place in Eight Mile Rock on Monday, November 5, affording residents the opportunity to learn more about the proposed programme, as well as to relay any suggestions and/or concerns they may have.

The initial implementation of the programme is expected to commence in April 2019.

NHIA Chairman Dr. Robin Roberts introduced fellow members of the authority that were present and shared a comprehensive presentation with attendees regarding the proposed programme. Attendees also had the opportunity to enroll in the already existing NHI Bahamas Programme, which has been in place since 2016.

“The people of The Bahamas, in all of our studies that we have done so far, have said that they would like to have a National Health Insurance Programme to be a very integral part of how we fund health care in The Bahamas, and that is because health care, we have found in most instances and for far too many individuals in this country, is far too expensive. They cannot afford it … we see the results of it, we see individuals who come too late, very late into the disease and they come when they have no choice and the disease is too advanced.

“We have other individuals who have actually used up all of their resources and taken out loans, and finally they come to the point where they have no more money and they have to seek assistance to pay for their care.

“When we have a resident in this country who has made major contributions to the development of this country and they happen to have had a condition, they have been treated for that condition, for all of the information they have, they have been insured for that condition, they have now retired, so they have lost their insurance and they are now being offered an insurance premium in order to keep their insurance of $3,000 per month.

“I would like to know how many of you, when you are in your 60s, can afford and insurance premium of $3,000. That is the reality of health care today,” expressed the NHIA Chairman.

He added that the discussion of implementing universal health care coverage in the country has been a topic of debate for quite some time; however, the time has come to have such a programme fully implemented to ensure that all Bahamians, regardless of circumstances, are fully insured to receive primary care access when they need to access it.

“This has been a long journey for us in The Bahamas. The first initiative that the government set out was in 1987, to have a national health insurance but it was not until April 2017 that the National Health Insurance Programme was finally rolled out. The government, in realizing the expense of that NHI Programme said that they would start off in a phased manner, because of the potential costs.

“They realized that it was far easier and better to have prevention as opposed to cure and so the first and only benefit at that time, was to have what we call primary care and that is, at least every month. Persons would be assured of having a doctor that, when they are in need of their general health care or have an urgent problem, that they would have a physician to which they are assigned, that they get to know and they will continue with them, to coordinate their care, in years to come,” said Dr. Roberts.

“The new NHI Board has been set up by the National Health Insurance Act, and we have been charged with the responsibility to expand this NHI Programme. We are very thankful for the reception that we have received on Grand Bahama, since yesterday and today.”

He disclosed that under the new proposed plans, which consists of three parts, persons will receive the Standard Health Benefit, the Employer Mandated Health Insurance and the Risk Equalization component, offering affordable and sustainable health insurance for all.

“The primary question that has been asked, in looking at this proposal so far with the NHI, is how it is going to affect their current health insurance programme that they have on their jobs, will it cost them more and what exactly will they have to pay.

“One of the pillars of the proposed NHI plan is to have an employer mandate. In the employer mandate, we are mandating that all employers will have the responsibility to ensure that their employee have health insurance coverage; the principal being that their employee is fundamental to the productivity of their job and, for their job to thrive, for them to continue to be productive, when the most important persons in their jobs have an illness, they must participate in seeing that that person can get back to work.”

Under the proposal, employed persons will be required to buy the standard health benefit through private insurance and will be required to pay a premium, between eight to $42 per month, depending on the employee’s income, while the employer will be required to make the remainder of the contribution, directly to the private insurers and not to the government.

Similarly, unemployed persons will also be eligible for the standard health benefit through NHI, at no cost to them. That aspect of the plan will also cover seniors, children and the indigent.

The redefined NHI proposed plan will include primary care, diagnostic imaging for example X-Rays and Ultrasounds and care for high cost conditions such as breast, cervical, prostate, and colorectal cancers, heart attacks, pacemakers and end stage kidney disease which requires dialysis treatment; all conditions which have become quite prevalent among Bahamians in recent years.

Following his explanation on the NHI Programme, Dr. Roberts opened the floor to debate on the proposal.

One resident questioned how the NHIA foresees health care providers enlisted in the programme not becoming overburdened with the influx of patients that will be added to their care, through the programme. “I believe that that NHI is a good concept, but, when you talk about the doctors and health care providers, my concern is having an overload on some of our primary providers.”

In response Dr. Roberts noted, “We have a limit on how many patients that primary care physician can add into their portfolio, and we do that for the same reason, so that they are not overloaded. Secondly, they do not have to see that patient every week; if they are a good physician and they are instructing their patients appropriately, they may only have to see that patient once a year.

“The other side of the coin is that we also want to get quality, value, for what we are paying that physician. We want to know that they have a documentation of all of our patients, and their conditions.

“We are going to implement very shorty, an electronic medical records database where all the data that we need, in our day-to-day patients’ records will be in the computer.”

Another concerned resident expressed that she is a small business owner and as the proposed NHI Programme presently stands, the employer mandated health insurance premium would undoubtedly cripple many small businesses in Grand Bahama.

“NHI sounds really good, but it will be a strain on small business owners. I am sure a lot of you remember the Sewing Centre that is no more and with this, there are going to be a lot of us that are no more. We need to look at that.

“Grand Bahamians will not be able to afford this right now. In the future, yes, when the government does something with the hotels and other things here on the island. But for right now, it is going to be really, really heavy on our pockets.”

Dr. Roberts responded to her concerns stating, “What we are looking at is a collective responsibility that we all share in this. Yes, it may be a burden for you right now, but if you look at the other side of the coin. What I can say to you is that health is fundamental to economic development. All of the healthy countries have the best economies, they assure their workers that for every 10 years of life expectancy, the economic growth of the country goes up by .1 percent. They have shown that if you maintain a certain population of healthy workers for at least eight months, you have increased significantly the economic growth in that country.

“You should not look at health care as a liability; one needs to look at health care as a means of the betterment of economic growth because it is the production that is important.

“This is an investment to ensure that you will have the highest productivity in your company, in order to have better profits at the end of the day. Your point is taken, but if you use the economic argument I believe that you will have equally or greater value to what you are saying with regards to it being more of a burden for you; it may be your route for economic development.”

He added that her concerns were the primary reason for hosting such town hall meetings throughout the country, noting that the proposed program has not yet been approved by Cabinet, thus the position being taken by the NHIA to engage residents on public discussion and recommendations to the proposal.

“I welcome the comments and that is the reason that we are having this symposium. We know that we have some small businesses particularly, like in Grand Bahama, that will find this might put them out; there are those that say that we need to re-look at that aspect. This is what this forum is all about.

“Persons can make their case and I invite all to go on our website and state their cases so that we can take the concerns into consideration when we go back to the Board. More importantly, when we make our presentation to Cabinet, these are exactly the questions that Cabinet will ask us, how are we going to design this program to take the burden off of those that the contribution will affect the most,” informed Dr. Roberts.

The NHIA will continue its public discussions on the proposed health plan throughout The Bahamas. Their next targeted island will be Exuma on November 15 where fruitful discussions regarding the program will continue. Persons can view the entire proposal by visiting www.nhibahamas.gov.bs.

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