The discrepancy between the projected cost of National Health Insurance (NHI) per the government's consultants - Sanigest International - and the estimate from the private insurance industry is significant and glaring for all to see. While we wait on the government to give us another figure on the price tab for this scheme, it is obvious that it will cost the taxpayers quite a lot to pay for NHI. What makes this even more disturbing is that the government wants to collect and control hundreds of millions of tax dollars in order to give us quality healthcare as if it has earned our trust based on its track record in healthcare delivery over the years.
The cost of public healthcare
The current healthcare system is filled with so much deficiencies and inefficiencies, with overcrowded waiting areas and inadequate infrastructure to support the general population. The system is further burdened by illegal immigrants who do not contribute to the public treasury or the National Insurance Board (NIB) but enjoy access to healthcare in The Bahamas. A visit to the public ward at Princess Margaret Hospital (PMH) is all it takes to question the level of commitment of the government to providing quality healthcare to its people.
Besides the construction of the Critical Care Block, which has taken several years and is still not sufficient to meet the healthcare demands of this nation, what other upgrades have been made to the public healthcare system? Plagued with wastage, corruption, operational inefficiency and a poor records management system, the public health system in general and Public Hospitals Authority (PHA) have managed to erode any form of confidence we might have had in these institutions.
When considered against the perceived reluctance of the government to address the issues raised in the recent PHA audit, it is obvious that there is cause for serious concern. This is despite the fact that over $200 million of taxpayers' funds is allocated to this failed entity on an annual basis.
What will change with NHI?
The question then is: What will change with the introduction of NHI? The reality is that we currently have a national health service through the existing framework that includes PMH and our community clinics. NHI, it appears, is just being instituted to raise money to fund the existing inefficient healthcare system and to put all Bahamians, regardless of their incomes and preferences, in one big bucket. By doing this the government is seeking to control everyone's healthcare and take away individual choice. In essence, we are looking at a nationalization of the health insurance sector and socialized medicine.
Does the government believe that the operational inefficiency, inadequate infrastructure, shortage of human resources, flawed corporate identity and culture of wastage and corruption will suddenly disappear within the next seven months? Is it the belief of the individuals with political power in this country that the overburdened PMH and clinics and the impact of illegal immigrants will vanish come January 1, 2016? Perhaps the government expects that by taxing us to pay for NHI it will have enough money to add Doctors Hospital and other private medical facilities to the pool; individuals will simply just go to the private facilities with their NHI cards as there is sufficient capacity in these entities.
The reality of universal health coverage
In the push and rush to implement NHI, we should not be naive to think that it will be the panacea for all the problems within our current health system. National health systems are normally funded by taxes and it would be unthinkable to suggest that we can afford to implement NHI without either increasing current taxes or imposing new taxes.
Human nature is such that if an individual pays for a product or service, he or she will be inclined to put it to use. Hence, once the government begins to tax for the provision of healthcare and individuals now have access to healthcare, demand will rise.
The experience of developed countries such as France, Canada and the U.K., just to mention a few, is that universal health coverage increases demand for healthcare. Persons who would normally not buy a painkiller for aches and pains, or simply sleep it off, will now visit the clinic or hospital; worse still they will rush to the emergency room. Additionally, medical professionals became burdened with a significant increase in patients with many choosing renowned doctors.
As a result, doctors spent less time with their patients and rushed them out in order to attend to the long lines in their waiting rooms. This took a toll on the doctors and the significant increase in demand also led to rapid deterioration of medical facilities. The end results were long waiting lists with patients waiting for over a year for certain procedures; some even died while waiting.
Medical costs and insurance premiums
Medical inflation is the increase in the cost of healthcare services year on year. It is well known that the cost of healthcare is constantly rising and continues to account for a high percentage of national budgets the world over. New procedures brought about by medical advancements are quite expensive and the development of new medicines comes at a high cost.
The level of utilization also plays a role in the cost of healthcare; simply put, the more you use the more it costs. In The Bahamas, we utilize rates developed in the U.S. for healthcare services provided locally without considering the true cost of providing the service within this country. Rising medical costs is a global phenomenon and, as Tower Watson's survey on 2011 global medical trends, which examined 37 countries, showed, the medical cost trend has exceeded general inflation rates in 95 percent of surveyed countries.
The premiums charged for medical insurance in The Bahamas are high and put this beyond the reach of numerous Bahamians. The health insurance companies maintain that the cost and rising cost of health insurance is due to the high cost of healthcare in our country. It is common knowledge that the price of healthcare service is often adjusted based on whether a patient has health insurance or not. Adding VAT on medical insurance premiums just shows the disingenuousness of the government to really assist in bringing down medical costs for Bahamians but rather to assure that medical insurance stays beyond the reach of many Bahamians.
Conclusion
The government cannot ignore the points noted above as it seeks to bring about universal healthcare in The Bahamas. What will be done to reduce the cost of healthcare and medical insurance premiums? How will the system be strengthened to withstand the pressure of increased demand on the health system once NHI is implemented? Will the government be relying on the same individuals within the public service and the ineffective management teams to run a new system funded by the taxes paid by the people from their hard-earned wages?
The month of May is basically gone and yet we have no answers to several questions raised by the numerous stakeholders. The coalition is concerned that the government is underestimating the magnitude and amount of work needed to make the dream of NHI come true. We have no time to waste on rhetoric by politicians and it is high time our political leaders started taking this issue more seriously. They reference the number of persons who are dying due to lack of access to healthcare but omit the fact that the public system for which they are responsible is the major cause of these deaths.
We must be honest with the Bahamian people as to how much NHI will actually cost and admit that we can only afford a streamlined benefits package. The government should also move away from self-denial and admit that it is challenged to efficiently run any organization and requires the assistance of the private sector to properly implement NHI.
More importantly, the minister of health and his colleagues need to come down to Earth from their fantasy lands, be realistic in their approach and start taking real steps to address the real issues within our health system.
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