Attendees at a town hall meeting to discuss the proposed NHI scheme. The Bill before Parliament has been endorsed by KPMG, which helped to organise events to engage the public.
By RASHAD ROLLE
Tribune Staff Reporter
KPMG, one of the Christie Administration’s lead consultants on National Health Insurance, yesterday supported the administration’s recently tabled NHI Bill, claiming that significant changes have been made to the original draft.
KPMG was hired by the administration within the last year to validate its NHI plans. The firm has since played a major role in trying to increase engagement between the NHI secretariat and Bahamian stakeholders.
According to a document released by the NHI Secretariat, which featured the feedback stakeholders and consultants had about the draft bill, KPMG was critical of the governance structure of the National Health Insurance Authority (NHIA) as mandated in the original draft bill, saying it allowed for “heavy political control with board appointments, staffing decisions, and other key decisions being ultimately at the direction of the “minister.”
“This will create immediate distrust with other providers, insurance companies and administrators that the entity will be politically managed,” KPMG said.
After some changes were made to the bill, KPMG now appears supportive of the governance structure, saying in a statement released yesterday:
“The governance structure for the National Health Insurance Authority has undergone significant review and changes pursuant to stakeholder feedback since the first draft of the NHI Bill, and we believe this governance structure is now well balanced and reasonable for an authority of this nature.”
The statement continued: “The National Health Insurance Bill was tabled in Parliament on Wednesday, August 3, 2016. Extensive stakeholder consultation comments and responses on the draft NHI Bill were also published by the NHI Secretariat on its website. We understand that in the spirit of transparency, all stakeholder feedback received over the past several months, inclusive of KPMG’s initial recommendations, has been disclosed to the public through the publishing of a feedback table on the NHI Secretariat’s website.
“We note certain of our recommendations have also been discussed in recent press articles. As advisors to the government of The Bahamas on the implementation of National Health Insurance and wider Universal Health Coverage Reform, KPMG has been involved in ongoing reviews of the NHI Bill up to its recent finalization and presentation to Parliament.
“KPMG has worked closely with the NHI Secretariat and the Office of the Attorney General who have also been advised by the Government’s legal advisors, Hogan Lovells, and has made recommendations in the normal course of its advisory engagement with the government for improvement to the NHI Draft Bill which was released on February 18th, and to subsequent drafts. The final NHI Bill which has been tabled in Parliament, and which balances the views of many private and public sector stakeholders, is a fundamental step in the implementation of Universal Health Coverage The Bahamas, something KPMG fully supports.”
Regarding the governance structure of NHI, the most substantial change to the bill is the composition of the NHIA’s board and the selection of representatives on it.
The original bill mandated a board of twelve people, seven of whom were to be appointed by the minister responsible for NHIA. However, the newly tabled bill mandates that the board consists of nine members, five of whom are to be appointed by the minister and four who must simply be approved by the minister.
Additionally, the revised bill doesn’t require that the NHIA Board appoint an independent auditor approved by the minister as it gives the board the power to make this decision on its own.
Otherwise, the governance structure of the NHIA Board has not been changed substantially compared to the original bill. The new bill still grants the minister, for instance, the power to create regulations that could affect issues central to the operations of the NHIA, such as the process of enrolment of people into the scheme, the rate and mode of payment of contributions by beneficiaries and employers and the functions and procedures of committees established by the board. The minister also has the power to appoint the chairman and deputy chairman of the NHIA Board.
In addition, despite KPMG’s previous objection, the newly tabled bill still gives the minister wide discretionary powers to give directions to the NHIA, though the language on this has changed to suggest this power is reserved for emergency situations.
The bill says: “In the interest of the public’s health and where circumstances require immediate action, the minister may give to the Authority such directions as it appears to the minister appropriate, whether of a general or specific character and the Authority shall give effect to any such direction.”
In defending the minister’s role in the NHIA governance structure, representatives have said that the bill is in line with those created for other agencies and reflects the fact that in Westminster systems, responsibility for important issues ultimately lie with the minister.