By NATARIO McKENZIE
Tribune Business Reporter
THE BENEFITS included under the first stage of National Health Insurance (NHI), primary care, have been outlined in a “policy paper” released yesterday, along with other details of the health care scheme in the first comprehensive overview of the initiative.
As noted in the policy paper, entitled ‘Building a Healthier Bahamas’, NHI will be implemented in stages with coverage beginning with primary care.
“Coverage will begin at the primary health care level, meaning the outpatient, first level of care that focuses on prevention, and addresses and co-ordinates health needs,” according to the policy paper. The initial benefits covered by NHI Bahamas will include primary health care services at approved health care providers, such as newborn care, care for those with chronic diseases, care integration, counselling, home care and population health services addressing the social and other determinants of health.
The policy paper states that primary care will also include primary health care diagnostic, laboratory and other medical services, such as testing of blood sugar and cholesterol levels; personal preventative services, such as vaccines for children, scheduled preventative health visits, general screening for breast cancer or heart problems, and counselling and prevention of obesity, tobacco use or skin cancer; many primary health care prescription medications; and health education and promotion, for example: monitoring and promoting nutrition and hygiene amongst children and young adults.
“There will be no contributions or co-payments required to receive primary health care during the initial rollout of services under NHI Bahamas,” the policy paper states. “During the initial service-delivery phase, these services will be publicly funded from the Government’s central budget, as described in more detail below. During this stage, the Government wants individuals to experience the changes and improvements in accessing the health care system. This is a deliberate approach, allowing the population to gain confidence in the access to health care services and to provide valuable feedback on the reforms.
“Additionally, implementing NHI Bahamas in stages will allow the Government to properly assess initial utilisation rates, actual costs of service delivery and the evolving health care needs of the population.”
The introduction of primary healthcare was slated for April but, in late March, Health Minister Dr Perry Gomez acknowledged that there would be a delay so the Government could establish a public insurer.
As to the funding for the first stage the policy paper notes: “For the primary care stage of NHI Bahamas, the Government will manage finances so as to compensate providers through a National Health Insurance Fund (“NHI Fund”), financed through the Government’s consolidated fund. This stage of implementation will cost the Government approximately $100 million annually. Money will follow the patient and be linked directly to the care given, leveraging outcomes-based compensation models, such as “pay for performance” and other evidence-based arrangements. It is proposed that an additional, approximately $24 million a year will be reserved for coverage of selected high-cost specialised care. These initial costs will be paid by the Government as a transfer to the National Health Insurance Authority.”
It adds: “The legislative and regulatory framework for NHI Bahamas will also establish the NHI Fund to ensure full transparency and accountability. The NHI Authority will compensate approved insurers. Insurers, in turn, will compensate health care providers. As coverage and benefits expand under NHI Bahamas, funding will be supplemented by other sources. These may include a reallocation of the national health budget, new or supplemental broad-based taxation measures, dedicated funding streams and/or contributions. Regardless of an ability to pay, equitable access will be provided under NHI Bahamas.”