As the government issued a global tender yesterday for a company to run its public insurer for National Health Insurance (NHI), there remained uncertainty surrounding the timeline for NHI and whether the government will be able to constitute a public insurer and get stakeholders onboard within the next four months before its proposed January roll-out of primary care services under the universal healthcare plan.
Asked whether primary care services under NHI will be rolled out in January 2017 as set out by the government, Damara Dillett, the legal consultant to the NHI Secretariat, said, "At this particular juncture we are waiting for the NHI Bill to officially become [the] NHI Act so we can meet with our policymakers and make those critical decisions, and advise the public right away.
"Before now we had absolutely no authority. NHI did not exist on the books. Now that we have that legislative power we are able to make the critical decisions that are necessary."
The NHI Bill was passed in Parliament last Monday.
Pressed for an updated timeline on the next phase of NHI, Dillett said, "It gives us the opportunity to strategize as it relates to the timeline, having regard to the first step, which is the passing of the NHI legislation."
Primary care services under NHI were set to begin in April.
Days before the roll-out, Minister of Health Dr. Perry Gomez said it will be delayed by six months.
Primary care, a subset of the vital benefits package, is a basic level of healthcare that includes programs directed at the promotion of health, early diagnosis and prevention of diseases. It also covers laboratory work; diagnostic services such as X-rays, mammograms and prostate exams; and the medications required from primary care.
According to the government, primary care services under NHI will initially be administered without cost.
In its latest policy paper, NHI Bahamas said as coverage and benefits expand under NHI, funding will be supplemented by other sources, including "a reallocation of the national health budget, new or supplemental broad-based taxation measures, dedicated funding streams and/or contributions".
Medical services providers have yet to sign onto the scheme. Regulations also have yet to be completed to flesh out the details of NHI. The NHI Secretariat was unable to provide a timeline for the completion of the regulations.
Legal consultant of the National Insurance Secretariat Damara Dillett addresses members fo the media.
"We are working very hard towards completing the regulations," Dillett said. "We have internal deadlines. We are trying to ensure that the framework is put together in such a way that we can now go out and engage with the stakeholder industry to get their input on the regulations."
Gomez said last week that NHI does not mean beneficiaries will have to give up their private insurance benefits, but it will allow them to renegotiate their private plan to only pay for services outside of those covered under NHI.
Schedule and cost
Dillett said the public insurer will only administer NHI benefits, while services outside the scope of NHI, referred to as "supplemental benefits", will be exclusively available via private insurers.
According to the target schedule outlined in the request for proposals (RFP) document, the government will select a preferred bidder to manage its public insurer by October 28, 2016, execute a service agreement by the end of November and launch the public insurer by the end of this year.
As a part of the management services agreement, the company is expected to present a three-year business plan. It will be responsible for claims and case management, handling and processing requests for payments, health risk management, wellness management services, beneficiary and provider relations, communications with and education of beneficiaries and providers, and the management of NHI funds and other services as detailed in the services agreement.
The government has budgeted $100 million for the first year of primary care services under NHI. But the full cost of NHI remains unclear. Government consultants, Sanigest Internacional designed the NHI scheme and estimated it would cost between $362 million on the low end and $633 million on the high end. But the Bahamas Insurance Association (BIA) priced NHI at more than $1 billion.
The association asserted that the Sanigest NHI model represents a "hostile takeover" of the private health insurance sector and the "nationalization of private assets".
The government engaged KPMG earlier this year to advise on NHI.
When asked if Sanigest's plan had been scrapped in favor of KPMG's advice, Permanent Secretary for the NHI Secretariat Peter Deveaux-Isaacs said, "Sanigest did a lot of credible work for the NHI plan, so some of the work has been incorporated, much of the work has been incorporated into what KPMG is doing."
NHI Project Manager Dr. Delon Brennen speaks to members of the press. (Photos: Torrell Glinton)
But he could not confirm how much Sanigest was paid, noting that the Ministry of Health contracted the Costa Rican-based company.
Asked for KPMG's consultancy cost for NHI, Deveaux-Isaacs said, "We'll let you know that in due course."
Royston Jones Jr., Guardian Staff Reporter
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