The first year of primary care services under National Health Insurance (NHI), scheduled to begin in April, will cost around $100 million, according to Deputy Chief Medical Officer Delon Brennen. The figure includes the cost associated with registration that starts in January, 2016.

Brennen, who appeared as a guest of Guardian Radio 96.9 FM's radio talk show "The Revolution" with guest host Quincy Parker, expounded on the government's proposed primary care package and the vital benefits package. Brennen said eligible beneficiaries are now being identified through the combined efforts of the National Insurance Board (NIB), the Office of the Attorney General, Insurance Commission of The Bahamas and Department of Immigration.

Using NIB's database, eligible beneficiaries will be registered for NHI, provided a smart card, and allowed to choose their primary care provider as well as their insurer from among those who enroll, according to Brennen. He said the entire group of beneficiaries; citizens and legal residents will total around 350,000 people. The vital benefit package includes outpatient services, specialist services, hospitalization and surgeries.

Primary care services are a subset of the vital benefits package, Brennen explained.

"When you go to your family physician, your general practitioner, to your pediatrician, your internist, your antenatal care from your OB/GYN, that package of services is delivered in an outpatient setting that is delivered to each and every one of us," Brennen said. "You need to have a physical exam done. You need to have a health maintenance exam done. You need to have a set of vaccines.

"You need to have that kind of service delivered to you in an outpatient setting. You have a minor illness or injury; you have a cough; you have a laceration that can all be done -- you don't need emergency services -- but it can be done at a clinic whether private or public; those services would be covered under primary care."

Primary care would also cover laboratory work, diagnostic services such as X-rays, mammograms, prostate exams and the medications required from primary care is rolled into primary care package of services.

Asked when the full vital benefits package will be rolled out, Brennen said he believes that depends less on the political directorate and more upon of the Bahamian people, despite the government having the ultimate say on the timeframe for each phase of NHI.

"The reason I say that is because the understanding of when we want those things to be rolled out, the reality of we have to then pay for it comes into play," he said. "Right now, the expectation with these primary care packages of services will not require any new taxation. They won't take anything out of your paycheck. Nothing new will come out that has not been done before, but we are repurposing some of the funds that are already in the consolidated fund into this care package."

Prime Minister Perry Christie said in October the government is considering introducing a tax to fund NHI in the next fiscal year. However, Christie stressed that the government does not intend to do anything to disrupt the economy.

Speaking to the compensation cap, Brennen said the amount per person, per year is a predetermined amount delivered to the provider. He explained that if 100 children chose a particular pediatrician, that provider would receive $100 per year per child -- $10,000 per year in 12 installments. He said whether a child shows up to that pediatrician or not he or she will still receive the allotment, but the quality assurance in the system will analyze a range of details, including the vaccination rate, how many people receive an annual physical exam and routine vaccines, to ensure quality care in being provided.

Brennen said there is nothing wrong with a provider having a profit margin, but he or she cannot restrict access to service in order to widen the profit margin.

Sanigest Internacional has estimated that NHI would cost between $362 million on the low end and $633 million on the high end. The Bahamas Insurance Association said last week the proposed NHI model constitutes a "hostile takeover" of the private health insurance sector and the "nationalization of private assets". PricewaterhouseCoopers has said the implementation of NHI as it is currently proposed has the potential to "seriously destabilize" both the public and private sectors of the health care system, risking the successes of NHI.

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