Despite the government's plans to introduce the first phase of National Health Insurance (NHI) in less than two months, Prime Minister Perry Christie was yesterday unable to say just how much the universal health care scheme - or the first portion of it scheduled for a January 1, 2016 rollout - will cost.
Addressing the Bahamas Institute of Chartered Accountants' Extraordinary General Meeting yesterday, Christie reiterated that his administration would not implement a universal healthcare plan that would damage the Bahamian economy, but once more remained tight-lipped on cost or financing details despite growing public demand for hard figures and the government's implementation strategy.
"I don't think anybody would want a country that introduces something and not be able to finance it - [where] halfway through you find out that you can't finance it.
"I don't have the concern about whether in January I'm introducing a benefits package - that seems to be the concern of the insurance industry. We're going to phase it in; we're going to have our accountants be very clear in what it's going to cost, and we're not going to [charge] what the country cannot bear.
"That's what accountants do for us. It's very difficult, very complex to work these things out, but we are not going to have people who die because they are poor," stated Christie.
The Christie administration is expected to roll out the first phase of NHI, focusing predominantly on client registration, on January 1. However, a review of the costs and funding of NHI conducted by PricewaterhouseCoopers (PwC) outlined potential challenges in the base level tasks associated with patient administration and structural improvements to the Public Hospitals Authority (PHA) on top of weighty concerns about the government's scant details on NHI's financing mechanisms and governance structure.
"A fundamental change to the method funding hospitals is a multi-year process, and success depends on a number of important building blocks, such as robust and reliable costing information, patient information systems and accurately coded records, none of which exist within the PHA at this time... In anticipation of NHI, the most urgent priority for PHA is capacity building and not a new payment mechanism," stated the PwC review.
The report, obtained by The Nassau Guardian earlier this month before being published in part in daily newspapers on Monday, stated that the government would have to curtail the health services offered through the Vital Benefits Package and would have to further raise tax revenues if it wished to begin BHI implementation in January 2016.
PwC stated that NHI had the potential to "seriously destabilize" the public and private sectors of the country's healthcare system, even with those compromises in place. The review, which focused on the NHI cost estimates that health consultancy Sanigest Internacional presented to the government, additionally stated that it could not validate several of Sanigest's valuations.
Sanigest valued a Vital Benefits Package for NHI at $362.6 million per year, while the Bahamas Insurance Association (BIA) estimated the cost of such a program at closer to $1 billion annually. However, PwC found that the government only had $237 million funds available for reallocation within the Ministry of Health, leaving an annual funding shortfall of $125.6 million, using the Sanigest estimate.
Consultations and costs
BIA members yesterday voiced their frustration with the implementation process on 96.9 Guardian Talk Radio's Morning Blend with host Dwight Strachan. Marcus Bosland, a member of the BIA's NHI Committee, revealed that the BIA had still not officially received copies of PwC's review from the government, even after the report was leaked to the media, on the basis that the government found the contents of the review "inconclusive".
Tina Cambridge, regional director of Generali Worldwide, stated that the BIA was still not "meaningfully engaged" in consultation with the government over NHI's implementation, despite meeting with key NHI players, including the recently appointed permanent secretary with responsibility for NHI's implementation. While Cambridge and Bosland stated that last week's meeting involved the BIA providing industry information to the government, Cambridge noted that the BIA was still "very anxious" to work with the government on the massive project.
Click here to read more at The Nassau Guardian
