Registration for the National Health Insurance (NHI) scheme will co-opt the National Insurance Board (NIB) database and systems, according to Deputy Chief Medical Officer 3, who has confirmed the government's intention to use the National Insurance Board to smooth the process of registering hundreds of thousands of Bahamians and legal residents for universal health coverage over the first quarter of 2016. Brennen has also confirmed that the government plans to use the Consolidated Fund to pay for the delivery of primary care services at no new cost to the citizen, and gave the first real public discussion of the proposed capitation scheme.
Brennen has become the primary spokesman for the NHI scheme, in that he is the first government official to give concrete details of the scheme scheduled to be implemented in less than two weeks. Speaking with Guardian Business, he underscored some of the details he initially disclosed during an appearance on Guardian Talk Radio's "The Revolution", with guest host Quincy Parker. He said the primary care package, which is expected to cost the government $25 million per quarter, will be offered at no cost to the citizen.
The question of taxation arises in connection to the so-called Vital Benefits Package. That will require a tax: The government intends to go with a three percent payroll tax, split equally between employer and employee with the government picking up the slack for the unemployed.
"We are reapportioning or repurposing some of the funds that are already in the Consolidated Fund into delivering the primary care package," Brennen explained.
"So what's happening right now is the National Insurance Board is going through their database along with a concerted effort from the Office of the Attorney General, the Insurance Commission of The Bahamas and the Department of Immigration, so that we know and we can clearly identify through the legal channels, who eligible beneficiaries will be," he said.
Brennen pointed out that it is a simple thing to say beneficiaries would be citizens and legal residents of The Bahamas, but added that it would take the efforts of all the named entities to truly define and identify the potential beneficiaries.
"We need those agencies to be involved in specifying 'you are yes' and 'you are no'. So that's being ironed out for sure now, because we have a general definition for it but we're making the finer details so that once we launch registration, we know exactly who it is and yes or no decisions can be made easily," he said.
All told, he estimated that 350,000 people would be covered under NHI to have their primary care services delivered through National Health Insurance, beginning in the second quarter of 2016. Brennen said that for those who already have the new NIB card --which has a smart chip on it -- the registration process would be very simple.
"What we would encourage even prior to January is making sure that everyone goes out there and gets their new smart card. Once you do that, all your demographic details that are going to be needed for NHI will already be entered into the system because we are using that database from NIB to be able to do that," he said.
Once people have the smart cards, and the medical providers are in the database, and the insurance companies decide they want to "truly" participate -- as Brennen put it -- and join the database, people will be able to choose their primary care providers -- or the so-called "medical home" -- and they can choose their insurers, who will be the administrators of the plans.
"That's the only thing that is needed to be done, essentially, once you have your NIB registration completed."
Choice and capitation
Brennen said the presumption is that the overwhelming majority of doctors will sign onto NHI as primary care providers.
"If your doctor signs on as a participating provider in NHI, then yes you will be able to choose who you want to go to and register with. We are not making any attempt to restrict that choice. Now, of course, if your provider says they are staying out of the network, then NHI will not have the ability to pay that provider," he said.
He also pointed out the frequency with which one hears the various constituents voice their support for universal health care.
"They just want it to be malleable enough to fit into the kind of mould that they would like it to be in. Will we all get what we want? Absolutely not. We have modified the original offerings based on what the providers have asked for as well," he said.
Meanwhile, he explained that the amount of compensation each doctor will receive per person, per year is a set figure paid in 12-month allotments -- essentially a lump sum payment -- to care for the people who sign up with that doctor under the NHI scheme.
"That is essentially the capitation that is placed on you," Brennen explained, adding that the doctor gets paid the full allotment per patient whether or not the patient shows up. "But, the quality assurance and the monitoring and evaluation system says we are going to make sure that you are actually delivering service to them as well. So we're going to see how many of those people you get in for their annual physical exam, how many are getting their routine vaccines. We want to make sure you are delivering quality care for that capitated amount.
"If they come in for a sick visit, do they get an appointment in a timely manner? Are you actually seeing them? We want to make sure that the amount we are giving you to take care of them, that you are actually using it to care of them. There's nothing wrong with a profit. We understand -- there must be a profit -- but at the same time, you can't restrict access to service because you want to make the profit margin higher," he said.
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