By KHRISNA RUSSELL

Deputy Chief Reporter

krussell@tribunemedia.net

A CONTRIBUTORY scheme in which the salaries of every employed Bahamian will be subject to a deduction of about two per cent each month was proposed yesterday by the National Health Insurance Authority as a means to pay for universal healthcare coverage for all, including children, elderly, and the unemployed.

While NHIA Chairman Dr Robin Roberts was careful not to classify the proposition as an income tax, the details of how the deductions are to be made mimic that of such a tax.

The proposal is likely to also spark some push back as it mandates that those already subscribing to private insurers will not make any extra contributions but it would mean two per cent of payments to these insurers would go into the universal healthcare pool, Dr Roberts explained.

If a person earns $5,000 each year, a salary deduction of $8 per month will go into the National Health Insurance pool. Those with an income of $10,000 will pay $17 every month and a person that takes home $15,000 every year, their deduction will be $25 per month.

Those legally in the Bahamas earning $20,000 each year are expected to pay $33 each month; $25,000 a year will be $42 per month and those making $30,000 or more will contribute $42.

Officials say this is either 50 percent of the premium’s cost or a maximum of two percent, whichever is lower, of their annual salary. It is therefore proposed that the employer will be responsible for at least 50 percent of the premium or the remainder of the premium cost.

And no one will be excluded or charged more because of pre-existing conditions, Dr Roberts said.

Asked by The Tribune how the deductions were expected to coincide with the state of public healthcare, Dr Roberts said it is the intention of NHIA to minimise the level of “bad” care that patients receive as the scheme essentially makes everyone “private” patients.

He expects it to be at least another year before these deductions begin, if approved by Cabinet.

Timelines

The newly released NHI policy paper outlined several timelines: including April to July 2019 for the launch of the standard health benefit and NHI expanded coverage; July 2019 for a sugary drink tax and national wellness programme; a January 2020 launch of the employer mandate/two per cent deductions for businesses with 100 or more employees; and January 2021 employer mandate expansion for all employers and deadline for all grandfathered private insurance plans.

A 45-day public consultation with stakeholders, beginning yesterday, will also have to be completed at which time it is expected many suggestions will be made as to how NHIA should proceed.

“Everyone will be contributing,” Dr Roberts said yesterday at NHIA’s offices on East Street and Purpose Way. “Some will pay directly. The other half the government will pay so what we are looking at is called an employer manual.

“Everyone who is employed will be expected to have salary deductions.

“First of all, we don’t expect this plan to be implemented until for at least another year. Secondly, we are looking for those employers that have at least 100 employees that we think might have the capacity to carry the load.

“Those that have less, we would expect for them to make a small contribution for each of their employees and for those individuals not employed, then we would expect that when they go to the government healthcare services that they would enrol in the same way they are enrolled now in our primary healthcare services that in order for them to get these benefits senior citizens, retirees, children, unemployed they would be carried by the system as a part of the shared responsibility.

“So, it is in our best interest then to get the economy going quite well such that everyone, as many people as possible are employed but more importantly as you spread the risk across the population that everyone who is working, I would expect that it would drop the premium significantly and so therefore we could have more affordable premiums as there are those who would prefer to have private care and such that again it would take more off the burden of the public.”

To those who say the fees are not affordable, Dr Roberts compared the cost to four Kalik beers.

“One of the major problems in our healthcare system is we lack equity. Those who need care can’t get it and those who need more can’t. We just don’t have the money. One of the things we have is you will find very few places will pay insurance for individuals who make minimum wage, so what we are looking at is even those who make minimum wage will make a contribution but in those instances, we expect the employer to pay a little bit more for them.

“They are paying $10,000 per year. We expect them to pay $17 per month towards their health insurance, that’s the cost of less than four Kaliks depending on where you go to buy it. So instrumentally we have attempted to make this as affordable (as possible) and if you are above $25,000 the maximum you will pay is $42.”

Apart from the salary deductions, the authority is also proposing that funding come from government contributions from the national budget; earmarked allocation of value added tax collected on private health insurance premiums; distributions from the risk equalisation fund; and the sugary drink tax earmarked for an NHI wellness programme.

‘Christian values’

Primary care services also will be expanded in this under this new proposal to now include cancer screenings for the most common cancers in the Bahamas, new diagnostic imaging services – various x-rays and ultrasounds, including prenatal ultrasounds.

Dr Roberts said: “We took the Bahamian approach, never hang your basket higher than you could reach. The question would be what can we afford?

“We proposed to implement an essential package of benefits – a high cost care programme to include comprehensive coverage for select conditions or treatments, all of which have a high prevalence in the Bahamas namely breast cancer and cervical cancer in women, prostate cancer in men, colon cancer and rectal cancer that occurs in both with attention to high prevalence in diseases of the heart and blood vessels. We focus on heart attacks and its related health problems.

“We also included pacemakers for when the heart beats irregularly and death is impending.

“Finally, we included the caring for those with end stage kidney disease not only to better their dialysis care but to include the scope and the hope for a kidney transplant.

“These proposed changes and funding of National Health Insurance are grounded in our Christian values. We are our brother’s keepers. It is what we do for the least among us. It is one of shared responsibility fairness commitment to the community and working forward upward and onward as a people to achieve the triple aim of healthcare to better the patient experience to improve the health of the population and to give us the best value for the money we have,” he told reporters.

Officials say under this new model, NHI will act as a catalyst for change in the way Bahamians experience healthcare by implementing a value based payment system that incentivises providers to improve the quality of care by tying a portion of provider compensation to service quality.

Providers will be incentivised to follow best practises, be proactive and preventative in their approach to care and collaborate with each other for the good of the patient.