A top Bahamas Insurance Association (BIA) official has said there appears to be contradictory "factions" within the government's planning process that have left private insurers largely in the dark, and has called for "real consultations" between the government and representatives of the private insurance sector over the implementation of National Health Insurance (NHI).

Speaking with Guardian Business, BIA Chairman Emmanuel Komolafe posited that lecture series and ad hoc meetings with members of the BIA and individual insurers did not constitute adequate consultation with the private insurance industry, especially if the suggestions and recommendations put forward by the BIA are not being discussed or incorporated into the proposed scheme. He noted that in relation to NHI and other matters, the insurance industry is united and speaks with one voice through the BIA. This comes after recent comments from Minister of Health Perry Gomez suggested that the government was satisfied with the current level of insurer input in shaping NHI.

When NB12 questioned Gomez on the insurance sector's concerns the minister suggested that while future consultations with stakeholders were not out of the realm of possibility, they were not a pressing matter.

"There have been consultations, maybe not to the extent that they want. Perhaps we have to continue to do more but we have been in consultation with them in several meetings... I think the question is the amount of consultation so we're open for it," said Gomez.

However, Komolafe told Guardian Business that the BIA had yet to receive any formal government response to the BIA's position paper on NHI more than two months after it was published. He noted that the Office of the Prime Minister and National Security Minister had acknowledged receipt of the paper recently: the document was sent to all cabinet ministers. That paper, which warned against a "hostile takeover" of the insurance industry, charged that Costa Rican health consultancy Sanigest Internacional had undervalued the true cost of implementing NHI by some $300 million.

Sanigest presented the government with a range of NHI schemes costing between $362 million on the low end up to $633 million annually. However, the BIA's position paper argued that the true cost of NHI could cost upwards of $1 billion.

The BIA issued a strongly worded statement last week charging that the government is sending "mixed signals" regarding the way forward with NHI. The insurers said that they were"seriously concerned" that Sanigest appeared set in its implementation plans without further consideration of the BIA's recommendations as outlined in their position paper.
This, the BIA believed, contradicted Christie's earlier vow of considered consultative work with the private sector stakeholders private health insurance companies in relation to the design and implementation of NHI.

"We call on the government to bring some order and structure to the implementation and consultation process in the national interest. It is apparent that there is a lack of coordination between the ministries, agencies and consultants involved with helping us achieve the progressive objective of universal health coverage," read the BIA's earlier statement.
When asked about the government sending "mixed signals" regarding consultation with private insurers, Gomez only replied: "I don't know anything about that."

Gomez's announcement that the government had developed a vital benefits package was a particular sticking point for the BIA, which stated that it had given no input in such development. The lack of consultation, Komolafe argued, demonstrated a "total disregard" of the BIA's concerns and position paper. However, Gomez had indicated that wide-ranging industry participation would be sought in defining the vital benefits package and additional services. He spoke at the Ministry of Health and Pan American Health Organization (PAHO) Workshop on UHC last month.

"Most of the thinking and ideas around the vital benefit package, the proposed Model of Care, and the concepts of the pathway to single governance, will be re-visited, fine-tuned and crystallized for harmonization and synergy.

"The preparedness process has not just began in earnest but is gaining momentum as the involvement of stakeholder groups are expanded with in-depth participation," Gomez said at the time.

Komolafe felt as though Gomez's contributions contrasted "night and day" with Christie's budget communication indicating the way forward on NHI. The Prime Minister had stated that NHI will be phased in to ensure that it is affordable and sustainable. He also promised better private sector consultation while confirming that the scheme would be rolled out in phases to minimize any disruption to the economy; comments that were well received by the BIA. The BIA, Komolafe said, was now left waiting for the government to clarify its course of action.

"The industry is prepared to make sacrifices where appropriate to make universal health coverage a reality in The Bahamas. We are aware that our business models and product offering may have to evolve as we work with the government to achieve the noble goal of UHC. However, if there's a disregard for what we're saying and they just keep going along with whatever their proposal is, it makes cooperation and collaboration much more difficult," said Komolafe.

The government's rhetoric has lent credence to Komolafe's concerns. Although Christie has remained committed to advancing NHI in January 2016 with the input of industry stakeholders, Minister of Labour and National Insurance Shane Gibson last month dismissed the BIA's concerns by insisting that "they are at the table."

Despite the present concerns over inadequate input in driving NHI, the BIA has voiced its support of UHC in The Bahamas. Other private sector associations, such as the Bahamas Chamber of Commerce and Employers Confederation (BCCEC) and Bahamas Hotel & Tourism Association, have also thrown their weight behind the push for UHC but have called for wider consultations and cost analyses.

"While the government is doing its best to address the myriad challenges we face, we are still confronted by low economic growth and high unemployment. The last thing you want to do is further disrupt the economy by not implementing an important initiative as UHC properly in a manner that is affordable and sustainable because you have the wrong figures," Komolafe said, noting that the stark difference between the BIA's and Sanigest's cost estimates warranted greater dialogue between the relevant parties. Moody's had earlier expressed some concerns while commenting on the 2015/2016; stating that the government's NHI plans may create "upward pressures" on recurrent revenue.

Although Komolafe welcomed the prime minister's allocation of $60 million to help strengthen the existing health system starting in 2016 over a predicted payroll tax, he remained concerned over the dearth of information regarding a timeframe for implementation.

"We are appealing to the Prime minister to bring some order to the consultation process and make sure that everyone is on the same page.

"It appears that there is currently a disjointed and uncoordinated approach to the implementation of UHC with responses to queries varying depending on the Ministry or audience. This is why it's important for the government to reign this in as soon as possible to address the misinformation, confusion and resultant uncertainty presently surrounding NHI," said Komolafe.

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