The Bahamas Insurance Association (BIA) yesterday released "A framework for universal health coverage in The Bahamas", its revised counterproposal to the government's National Health Insurance (NHI) scheme. The document stresses the BIA's support of universal healthcare in The Bahamas, and the recognition of the importance of health insurance coverage, equal access to essential healthcare services and quality in the delivery of those services.
"In our current healthcare system, private insurers offer consumers a range of benefits, both essential and supplemental. Employers and individuals are able to choose the level of benefits desired. Many of the benefits offered by private health insurance plans today would not be considered essential benefits, but simply make a wider choice available to consumers.
"The government's key NHI objective is to ensure access to essential benefits for all legal residents. The BIA has formulated this framework proposal as a way to achieve such an expansion, with minimal cost and disruption to the economy."
Some of the highlights of the proposal are listed below.
The first pillar of the BIA's proposal is mandatory health insurance for legal residents. All legal residents would be required to enrol in a private health insurance plan that offers at least the minimum essential benefits specified by the Ministry of Health, and all employers - other than those the government chooses to exempt based on size or other criteria - would be required to provide health insurance for employees and their dependents under age 25. Failure to do so would incur a penalty. All employee health plans would be required to cover the government-mandated minimum benefits package, but other benefits could be added.
"Individuals not covered by an employer-sponsored health plan would be required to buy insurance, failing which they would incur a penalty. The self-employed would have to certify health insurance coverage to obtain or renew a business license.
"A government assistance program (GAP) would either fully or partially subsidize the purchase of health insurance by those individuals or employers who could not afford to do so on their own. Those enrolled under the GAP would be entitled to receive the government-mandated health benefit package, administered by a health insurer approved by the Insurance Commission of The Bahamas."
The next plank is to have the essential benefits package defined by law. Under this rubric, the BIA calls for any insurer wishing to provide benefits under the NHI program to register with the Insurance Commission of The Bahamas and be required to offer a plan that includes the legislated minimum benefits package. Supplemental benefits could also be offered.
Next, the BIA focuses on legislation governing comprehensive insurance benefits. Focusing on exclusions, insurers would be unable to deny coverage for pre-existing conditions or age under the government-mandated benefits package. Looking at portability, employers and individuals seeking to change from one health insurer to another would be able to do so on the policy anniversary, or in accordance with the terms of the insurance contract.
The BIA also stressed a controlled premium price for essential benefits plan.
"With the goal of offering affordable premiums to the general population, a maximum level, or premium ceiling, would be set by an appointed body established by law for this purpose. This body would include representatives from the industry, the government and civil society. Insurers would offer the mandated benefits at a price not exceeding the established ceiling, which would be reviewed annually. The premium price would be based on standard actuarial and insurance practices," the BIA proposed.
One of the most important aspects of the proposal is the BIA's call for fees for medical services to be capped.
"Medical providers would be reimbursed based on an established rate for services provided under NHI. All providers who are contracted to provide service under the NHI program must charge no more than the established fee schedule, which would be determined in consultation with the Medical Association of The Bahamas," the proposal said.
The association argued that both private and public healthcare providers would benefit from the BIA's proposed framework.
"Private doctors would see more patients, due to the expansion of insurance coverage. Public service doctors would have less of a burden, due to the anticipated shift of patients to private caregivers. This should produce a better quality of care and better outcomes overall," the BIA said.
"Although capitation is accepted as the most expedient manner for reimbursement of healthcare providers initially, the ultimate goal should be to adopt a pay-for-performance approach, which is widely used in countries that have implemented universal healthcare. This system allows physicians to be compensated based on performance. It provides incentives to medical providers to comply with patient care procedures and to mitigate unnecessary costs," the association added.
Another vital part of the proposal is that there be no public insurance agency/company.
"The Bahamas has a robust private health insurance industry which has proved to be successful both in its product offerings and delivery of services... A considerable body of evidence supports the view that market-based systems overall produce better health outcomes for patients.
"Introducing a public insurer into the Bahamian market would duplicate efforts and deplete taxpayer funds. Major insurers already exist and have effectively provided healthcare benefits for tens of thousands of Bahamians over decades.
"These companies operate in a regulated environment, without political involvement, which allows for policies and services to be administered fairly and in a non-partisan manner. The BIA's framework for universal healthcare requires that all coverage be provided and administered by private health insurers. This will relieve the government of additional unnecessary bureaucracy, spur economic growth, and expand employment," the proposal said.
Another area of focus is enrolment. Once an employer has selected an insurer, the relevant information would be provided in order to enrol individual employees and dependents. The proposal also addressed premium payments and taxation. The BIA urges the removal of value-added tax on all medical services and medical insurance in the interest of making healthcare more accessible and affordable. The association also focused on a catastrophic fund, overseas care and consultation in the proposal.
"In order to flesh out the details of this framework proposal, the BIA requires information on the specific benefits that will be included in the government-mandated plan, an updated implementation timeframe for the NHI program, and a clear view of how the government intends to improve the health services infrastructure. The BIA welcomes the opportunity for detailed discussions with the government and other major stakeholders," the proposal concluded.
Click here to read more at The Nassau Guardian
