Monday, January 8, 2018
By NEIL HARTNELL
Tribune Business Editor
THE Government is planning to refocus National Health Insurance (NHI) on catastrophic care, believing a $60 million budget "could do an awful lot if properly managed".
Dr Duane Sands, minister of health, told Tribune Business that he and the NHI Authority Board were "headed" towards an NHI that protected Bahamians from "financial ruin", with the structure likely similar to Uruguay's catastrophic healthcare model.
Primary healthcare will remain part of the scheme, but Dr Sands reiterated that Bahamians would have to pay "very reasonable" fees to ensure NHI 's long-term sustainability in return for obtaining "a security blanket to avoid ruin from healthcare issues".
He added that Uruguay, with a population of less than four million, was providing catastrophic healthcare services that combat life-threatening illnesses and disease for "under $300 million". Accounting for differences in population size and economic structure, the Minister suggested the Bahamas might be able to achieve the same with one-fifth of the spend.
"The primary consensus for NHI is to provide assistance for people with catastrophic healthcare problems," Dr Sands told Tribune Business. "There's some benefits to enhanced primary care, but the biggest thing we need to roll-out very quickly is assistance with the likes of imaging, lab testing, immuno suppression, certain surgical procedures, joint replacement, cardio surgery. "These are the types of things, over the next six months, that Bahamians should be attempting to avail themselves of even as we identify a funding mechanism to achieve sustainability."
Emphasising that NHI could not be 'free', nor funded from the Public Treasury's Consolidated Fund as the Christie administration had sought to do, Dr Sands warned: "It's very clear we're going to have to find a method for payment, and the [NHI Authority] Board will float some recommendations based on a few models we've looked at where, for very reasonable rates, people have access to a security blanket or safety net to avoid financial ruin from healthcare issues.
"We expect the dollar amount per person, per family is quite reasonable, but it's not going to be a comprehensive cover medical plan. If we're going to keep NHI, then we have to figure out -beyond the hand-wringing - what the method of payment and contribution will be.
"The idea that NHI can be borne strictly by the Consolidated Fund is unreasonable, untenable and certainly unsustainable. What we're looking at is a plan that covers catastrophic ailments as a priority."
The former Christie administration, in launching NHI prior to the May 10 general election, focused on primary care services that combat regular, every-day illnesses and ailments. It allocated $100 million to this aspect of the scheme, although these funds were not specifically set aside from the Consolidated Fund, while providing just $25-$30 million for catastrophic care.
Dr Sands' comments indicate the Minnis administration plans to turn NHI 'on its head' by placing the emphasis on catastrophic, rather than primary, care. The Free National Movement (FNM) had looked at catastrophic health insurance as far back as 2001, when the Ingraham administration was in office.
"These are things Bahamians find themselves struggling with," the Minister said. "I could give you an example of a gentleman who received a kidney transplant and is now facing financial ruin because of the cost of immuno-suppression drugs. A patient with prosthetics. That represents a potential opening for NHI."
Dr Sands said a properly managed and funded scheme could have a "huge quality of life impact" for such individuals. "The model we looked at is the Uruguay model," he told Tribune Business.
"They have a population of under four million and have managed to provide catastrophic services for under $300 million. If you do the comparative arithmetic, and add in the efficiencies of the respective economies and the like, $60 million appropriately managed could do an awful lot to accomplish the same kind of catastrophic and critical healthcare services as they have managed to provide in a similar economy.
"We wanted to look very critically at that model because it makes an awful lot of sense to mirror that model in the Bahamas.... All of these thoughts would be subject to approval by my Cabinet colleagues once properly fleshed out, and then presented to the Bahamian public, but that's where we are headed."
Dr Sands reiterated that the "major sticking point right now" was "the massive stumbling block of the legitimacy of the programme itself", which was why he had sought a legal opinion from the Attorney General's Office on the actions of the former Christie administration.