By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A Cabinet minister yesterday confirmed The Bahamas will “eventually have to pull the trigger” on employer and employee funding for National Health Insurance (NHI) but it is “premature” to do so now.

Dr Michael Darville, minister of health and wellness, told Tribune Business the NHI Bill debated in the House of Assembly on Wednesday does “make way” for the healthcare scheme to adopt a model where it is financed by contributions from Bahamian employers, the self-employed and workers but such a move is “not on the table” at present.

Affirming that NHI will remain a government-funded scheme underwritten by Bahamian taxpayers for the foreseeable future, he added that multiple “preparatory steps” have to be implemented and completed before a scheme funded by business/employee contributions can even be considered.

These initiatives include upgrades to the existing public healthcare network’s infrastructure, the installation of new information technology (IT) systems and the time required for Bahamian private health insurers to adjust the pricing and content of existing medical policies and benefits packages to make way for the standard health benefit (SHB) introduced by the NHI Bill.

The minister also disclosed to this newspaper that the Government is “contemplating and working towards” the inclusion of universal dental coverage as part of its NHI strategy. He provided no timelines on when this would be achieved, or when the Government-managed scheme would switch to a model financed by the private sector, but indicated the latter will not occur under the Davis administration.

“It’s to be looked at down the line in the future,” Dr Darville replied, when asked about the Bill’s paving the way for NHI to be financed by taxes, levies or some form of contribution by Bahamian employers and the self-employed. “There’s so many things to be done before we even consider that.

“There are a lot of infrastructure upgrades that need to be undertaken, we need to implement IT systems, and we need to give private insurance companies time to put the basic package together. There needs to be some adjustments in the industry.

“There are a number of preparatory steps that must be done before we even consider that [outside sources of NHI financing]. It’s not really on the table. The legislation makes way for it.” Dr Darville said he did not draw attention to the relevant provisions in the Bill during the House of Assembly debate because they will not be enforced, or utilised, for some time.

He added that he left the clauses in there so that neither himself, nor any successor as minister of health, would be confronted with having to “go back and forth with the Bill” to seek continual amendments and changes from Parliament.

The NHI Bill’s section 15 provides for the NHI Authority, the body that governs the plan, to use “monies payable by an employer of an insured person, or monies or allowances payable by a self-employed person for standard health benefits or other health benefits under this Act”.  

Taxation, or some form of levy, imposed on employers and working Bahamians to finance NHI is far from a new idea. Who pays, and how much, have always been key issues ever since the scheme was first conceived by the initial Christie administration in the early 2000s. However, both employers and the self-employed are unlikely to welcome any new and/or increased taxes - especially at this time.

Dr Darville agreed that “there’s going to come a time” when NHI will have to switch to a contributory model, but pointed out that this will not be unique to The Bahamas as “every country in the world” with similar healthcare systems will have to do likewise if they have not already done so.

“I think we have something that industry is fully aware of, and people are fully aware of - that healthcare is a costly commodity to deliver and we have a lot of challenges in the country, and very soon we must take into consideration a new funding model for NHI,” he told Tribune Business.

“There’s nothing on the drawing board at this time as it relates to this being under active consideration. Eventually someone is going to have to pull the trigger on it. It’s premature at this time because there are so many preparatory steps that we have to take.”

Dr Darville said other Caribbean countries are “reaching out” to The Bahamas for advice and guidance on their own NHI-style healthcare schemes. He added that the Bill debated on Wednesday will effectively position NHI as the “default insurer”, or insurer of last resort, charged with covering the indigent and others who private carriers will not underwrite.

Describing the scheme as a “safety net”, he added that the Government’s goal is to ensure all Bahamians can access primary and tertiary care whenever needed in an affordable manner. Thus it views healthcare as a right, not a privilege.

However, NHI’s challenges with paying its existing bills - especially the sums owed to doctors and nurses providing care to its patients and beneficiaries - have caused the Opposition and others to question whether it makes sense to expand the scheme and its cost base before solving these issues.

Tribune Business reported at end-June that that the NHI Authority, which oversees the state-sponsored healthcare initiative that cares for more than 160,000 Bahamians, had again exhausted its annua; Budget allocation and was unable to pay sums owed to physicians and other service providers.

Christy Butler, the NHI Authority’s managing director and chief executive, in a conciliatory letter acknowledging the impact the scheme’s financial challenges are having on its service providers, attributed the woes to the inability of its “static” $46.2m annual Budget allocation from the Government to keep up with ever-growing patient numbers, its expansion and rising costs.

The Davis administration expanded the NHI Authority’s annual funding by $2m in the Budget, increasing it from $46.2m to $48.2m for the 2025-2026 fiscal year - an amount projected to remain the same for the following two fiscal years. For 2024-2025, NHI had used up $36.135m - some 78.2 percent of its full-year $46.2m allocation - by end-March, which marked the fiscal year’s three-quarter mark.

This suggested the remaining $10m was likely to be inadequate to see the NHI Authority through to the June 30 year-end. Mrs Butler, in her letter, sought to place the “delayed provider payments” in the context of the challenges caused by NHI’s growth and its unchanged financing that has failed to keep pace with this.

“Over the last few years, the NHI Authority programme has continued to expand with increased beneficiary enrollment, exponential growth in utilisation, particularly for laboratory services, and increased technology fees to accommodate an evolving programme with a demand for NHI Authority facilities and providers throughout the archipelago,” she wrote.

“Despite the programme’s growth and obvious success, funding has remained static. Additionally, NHI has experienced challenges related to regularised financing, which have made meeting our obligations to providers and vendors increasingly difficult.

“Although there have been previous payment delays, I recognise that this current delay has extended beyond our collective expectations and has put your organisation and operations in uncomfortable positions.”