The Bahamas Insurance Association (BIA) last night charged that the National Health Insurance (NHI) scheme has rejected the BIA universal health coverage proposal in its entirety, and once again charged that the Christie administration intends to create a public insurer to provide NHI benefits, an arrangement the BIA anticipates will be "another loss-making public institution that will be a burden on the Bahamian taxpayer and will provide poor service to medical providers and the public alike".

And the association revealed that PricewaterhouseCoopers (PwC) -- hired by the government to vet the Sanigest proposal for NHI -- had yet to arrive at a costing for primary care services under NHI. The association said it was asked to provide health insurance data to permit PwC to estimate the cost of the primary care phase of the scheme, and that its members have refused to do so.

Tension
As the administration ramps up to begin registering Bahamians for NHI, and just months away from the launch of primary care services under the scheme, the private insurers find themselves increasingly sidelined by a government apparently intent on proceeding with the NHI scheme as its consultants have recommended despite the objections of the two major planks of the scheme: the providers, that is the doctors who will provide the health care services and the insurers who will - in the absence of a public insurer -- administer it.

Against that backdrop, the BIA disclosed last night that it had been approached by the NHI implementation team to provide health insurance data to permit the government's consultant PwC to estimate the cost of the primary care phase of the scheme.

In a press statement explaining why its members have refused to share their data with PwC, the BIA said it has continuously expressed its willingness to urge its members to share this information with PwC with the understanding that there would be meaningful consultation between the NHI implementation team and the BIA on the design and implementation of NHI, including a formal response to the BIA's universal health coverage proposal which was provided to the government in November 2015.

Other caveats have included a provision that the health insurance companies' information would be held in confidence and would only be used to estimate the cost of NHI; that any report prepared which relied upon the data would be shared with the contributing health insurance companies and with the BIA, and that the NHI implementation team would provide the BIA with a number of documents to permit the BIA to be updated on the current status of the NHI design and implementation plans and to have a fair understanding as to how and when future consultations and discussions would be conducted.

"The NHI implementation team has since provided the BIA with an unsigned and undated response to its universal health coverage proposal that rejected every single recommendation made. Among other things, the government is intent on creating a public insurer to provide NHI benefits. The BIA has examined the reasons given for this and remains convinced that this will be another loss-making public institution that will be a burden on the Bahamian taxpayer and will provide poor service to medical providers and the public alike.

"Furthermore, at a meeting hosted by the Bahamas Chamber of Commerce and Employers Confederation on December 16, 2015, we were surprised to learn that the NHI implementation team had already completed the costing of the NHI primary care package," the BIA release said.

Dated
The association reported that NHI consultant James Cercone of Sanigest indicated that the insurance data relied upon in that costing was from 2007.

"In response to our concern that this was limited and out-of-date information, he indicated that the government was entirely comfortable with the methods used and results and is moving forward to implement NHI based on that information. It was also suggested that PwC had validated the cost estimates. The BIA notes that this was done without any consultation with the BIA or its members," the release said.

"In light of what has transpired to date, health insurance companies that are members of the BIA have unanimously agreed not to sign the NDA (non-disclosure agreement) or share any data with PwC at this time. It was further agreed that should circumstances change in a manner which suggests that our need for meaningful consultation is being taken seriously, the BIA would be more than happy to reconsider its position," the BIA said.

The following health insurance companies are members of the BIA:

o Atlantic Medical Insurance Limited;
o BAF Financial & Insurance (Bahamas) Limited;
o Colina Insurance Limited;
o Family Guardian Insurance Company;
o Generali Worldwide;
o New Providence Life Insurance Company Limited;
o BF&M Life Insurance Company Limited (not represented at the meeting at which the decision was made).

Frustrated
The association asserted that its repeated calls for meaningful consultation have thus far gone unheeded. Amid considerations that have already been voiced a number of times, the BIA said the NHI design and implementation process is so far advanced that the requested data will not add any value to the process.

"The NHI Implementation team and Sanigest have asserted that they are comfortable with their numbers which they claim have been validated by PwC.

"We have no reason to believe that any subsequent report by PwC will be given consideration based on the manner in which the leaked initial PwC report has been ignored. Among other things that report stated that "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".

The BIA said it regrets the current state of the debate concerning the implementation of "a progressive social initiative" such as universal health care for all Bahamians.

"Our position is based on what we perceive to be the determination of the government to proceed on its current trajectory in spite of the clear evidence that suggests that a different course of action is necessary," the association said.

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