President of investment and advisory firm CFAL Anthony Ferguson said the idea of introducing the Christie administration's National Health Insurance (NHI) scheme in January 2016 without a payroll tax to support it - supposedly to refrain from adding to the tax burden on Bahamians - is "hopeful, but delusional".
Chief Medical Officer in the Ministry of Health Dr. Glen Beneby told the Pan American Health Organization Symposium on Universal Health Coverage on Monday that the government was considering a payroll tax of less than three percent to fund the scheme, "but the aim is at the outset not to have it at all".
Ferguson noted that health is the biggest allocation of the national budget. He added that less than half the population is insured in a private program. The Department of Statistics has reported that 48 percent of the population has private insurance.
Ferguson explained that the annual payout is about $250 million, and said that if one added the private sector payout and the government's annual spend on health care, it's about $550-600 million.
"So, if you add the additional lives which would be covered now - the other 50 percent of the population - we can easily see this venture costing between $750 million and $1 billion. So, mathematically it's impossible to not charge a tax. And, to be frank, three percent won't cut it either," he said.
"I think to cover the additional lives it would be closer to six percent or more of payroll. This is against the backdrop of a well-managed, efficient program, which we know is highly unlikely given how government-related entities are managed. (The idea that the administration will be able to introduce NHI without a tax immediately) is hopeful but delusional," he said.
A number of private sector groups - the Bahamas Chamber of Commerce and Employers Confederation, the Bahamas Insurance Association, the Bahamas Insurance Brokers Association among them - plus individual businesses and commentators have warned that the timeline proposed by the government to introduce NHI - by January 2016 - is unrealistic.
The issue is the fact that the public health system in The Bahamas is perceived to be in disarray: Sanigest Internacional - the government's own consultant and the authors of the NHI scheme as presently composed - has pointed out the inefficiencies in the system, as have others, including the government itself.
CMO Beneby admitted at the symposium that the government has completed less than half of the items on its agenda to prepare the way to introduce NHI in January 2016. The government signed a $300,000-plus contract with Fred Perpall of the Beck Group to design a master plan for the Princess Margaret Hospital. It is not clear whether the government will use Perpall's plan as a catapult towards rationalization of the system before attempting to introduce universal health coverage. After all, Health Minister Dr. Perry Gomez is on record as saying the government will introduce NHI as planned despite the acknowledged issues.
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