August 27, 2015
Family Guardian President Lyrone Burrows on Tuesday night outlined the much-anticipated "vital benefits plan" (VBP) on which the National Health Insurance (NHI) scheme will be founded, and then poked holes in the plan, highlighting a number of deficiencies as seen by the Bahamas Insurance Association (BIA), Bahamas Insurance Brokers Association (BIBA) and other private insurance industry spokespersons.
Speaking at a Rotary Club meeting, Burrows disclosed that the package will offer:
o Primary care;
o Specialist care;
o Emergency services;
o Maternity and newborn care;
o Imaging services;
o Radiotherapy and chemotherapy;
o Mental health (acute and outpatient);
o Catastrophic (dialysis, transplants, cardiac, etc.);
o Essential pharmaceutical and lab services;
o Rehabilitation services;
o Air and ground emergency ambulance services.
Burrows' assertion was that there would be a number of implementation challenges, beginning with the one-year rollout, which he said was "unrealistic".
The BIA proposes a three to five-year rollout at a minimum, Burrows told the Rotarians. "Initial rollout should be broad not deep," he said, adding that the proposed VBP is "too rich for the current economy". Another set of challenges center -- in the BIA's view, Burrows said -- on the public insurer. He said the concerns include the duplication of resources and the inefficiency. Administrative costs in government agencies average 24 percent, versus 15 percent in the private sector. In addition, there is a perception of "unfair competition", given that the public insurer is backed by the public purse.
Burrows also raised corporate governance issues. The question is who would regulate, in order that there be no potential conflict of interest. Funding "Where is the money coming from?" Burrows asked. Sanigest estimated the cost of the VBP at $400 million or so, with an additional $200 million for the expanded package. The BIA's estimates are significantly larger: $603 million for the basic package, with an additional $362 million for expanded benefits. Regardless, the government's allocation for NHI is $60 million. And even if the VAT intake were included, VAT was estimated at $544 million.
Counter offer o Burrows reiterated the BIA's proposal: o Upgrade Existing Public Infrastructure o Make Health Insurance Mandatory o Allow Existing Insureds to Maintain Private Plans o No Pre-Existing Limitations on Vital Benefit Plan o Eliminate Public Insurer o Legislate Vital Benefit Package & Maximum Premium o Require Insurers to Offer Vital Benefits Package o Agree Capped Costs on Medical Services Local snapshot He stressed the BIA's support for universal health care, but expressed the reservations shared by the private health insurers: implementation must be carefully considered; collaborative effort amongst all stakeholders; phased approach required for implementation (Burrows cited Baha Mar as "a shining example"). "We only have one opportunity to get this right," he said. Spending on health in 2013 was $810 million, a full 9.7 percent of GDP.
There are 12 Life/Health Insurers, with three companies in run-off, and seven offer health insurance products. Private insurers showed $270M in premium collection in 2013, 75 percent in premium payout in health claims, with 33 percent of the population covered by private health insurers mostly through employer-based plans: 17 percent of the population covered through civil servant healthcare offering, and 50 percent of the population currently uncovered.
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