By RASHAD ROLLE
Tribune Staff Reporter
THE recent rejection of the proposed National Health Insurance model by industry stakeholders is “curious” considering the government had consultations and “fruitful discussions” with them about the scheme, NHI Secretariat Permanent Secretary Peter Deveaux-Isaacs said yesterday.
Everything appeared to be heading in the right direction for the NHI Secretariat until doctors and private healthcare representatives joined forces Wednesday to reject the government’s NHI proposal.
New government consultants from KPMG had recently stamped their approval on the secretariat’s plans. The postponement of primary healthcare provided it with a chance to continue stakeholder consultations and plans to establish a new NHI governance structure that would centralise the role of stakeholders in the NHI development process were set to be formalised next week.
Those efforts, however, have proven insufficient for key stakeholders, as nine groups on Wednesday formed the United Healthcare Reform Alliance (UHRA), rejecting the government’s proposed NHI model while threatening to withdraw its services if its demands aren’t met.
“It’s very curious to us,” Mr Deveaux-Isaacs told The Tribune yesterday in response to UHRA’s position.
“We have spoken to each and every representative we know to be a member of this newly formed alliance. We’ve spoken to them individually. We’ve had consultations with them and the consultations are ongoing. We’ve had fruitful discussions with them on the NHI bill. We’ve taken suggestions for revisions from stakeholders.”
Even though consultations between the secretariat and the stakeholders have ramped up in response to stakeholders’ criticism earlier in the year, UHRA on Wednesday called the NHI proposal unfeasible, flawed and unsustainable.
The group criticised the pace of improvements to healthcare services and hit out at the lack of projections about the cost of the government’s second phase of NHI: the vital healthcare benefits package.
At the centre of the government’s NHI proposal is one of the more significant points of contention: a plan to introduce a cost-controlling public insurer, a move considered so crucial to some that the government’s KPMG consultants advised it to postpone the implementation of primary healthcare services for months until the public insurer is up and running.
Mr Deveaux-Isaacs said officials are still working out the details of the request for proposals for a public insurer, adding that the secretariat had a lengthy meeting yesterday to discuss the matter.
However, UHRA insists that a public insurer is not necessary, saying in a press release Wednesday that “there is no need to establish additional government entities at the expense of taxpayers.”
In fact, the government’s terms for the ownership structure for the public insurer have not been finalised.
As for UHRA’s criticism of the consultations process, Mr Deveaux-Isaacs suggested that this caught him off guard given the secretariat’s plans for a new governance structure for NHI that is expected to be introduced next week.
“Based on the advice of KPMG, we will introduce a new governance structure which will include some members of private enterprise on the programme board,” Mr Deveaux-Isaacs said. “We’re just working to finalise the terms of reference for the board. Decision-making will rest with the government and it doesn’t mean we will change the model on account of just a single interest group but as opposed to external stakeholder consultations you would have them in the room with you while you are developing different aspects of the policy. You would have the Chamber of Commerce, the unions, the Christian Council and we will extend that to include other representative groups.”
Mr Deveaux-Isaacs said at some point planning must translate into policy that can be implemented to service the estimated 200,000 Bahamians who don’t have health insurance.
“The secretariat has an open invitation for all who wish to talk about NHI,” he said. “We know from the poll (done by the polling and marketing research firm Public Domain) that 80 per cent of Bahamians want NHI so we find this interesting since an overwhelming number of Bahamians support NHI, a policy that would reach thousands who don’t have NHI or the luxury to wait for NHI to be implemented.”
That poll also showed that Bahamians without insurance (75 per cent) are less likely than those with insurance (84 per cent) to have visited a medical professional in the past year. And of those surveyed, 44 per cent had attended a cookout or given to a fundraiser for someone they know to help cover medical expenses.
When asked yesterday whether the proposed governance structure meets its demands for transparency and engagement, Dr Sy Pierre, a spokesperson for UHRA, suggested it has the potential to.
“We are pleased to hear that the NHI Secretariat has decided to revamp its governance structure next week,” the spokesperson said. “We hope that the new structure will include all stakeholders. Our newly formed alliance will make it easier for the secretariat to reach out to all stakeholders in one single motion and bring us all to the table in a meaningful discussion regarding the way forward. “We share the same goal – ensuring that there is universal access to quality healthcare in the Bahamas. UHRA believes that universal healthcare is a noble and fundamental objective which should be afforded to all eligible members of the society regardless of age, gender, social status or employment status. We maintain that the government should leverage the existing infrastructure and expertise within the private sector to deliver universal health coverage to all and to develop the NHI funding mechanism that makes sense for the Bahamas.”