The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Bahamian health insurers last night “unanimously” withdrew all co-operation with the Government’s National Health Insurance (NHI) costing exercise, due to the latter “entirely ignoring” advice submitted by themselves and others.

The Bahamas Insurance Association (BIA), in a statement issued on its members’ behalf, accused the Government of being “dismissive” towards its proposed NHI alternative and determined “to proceed on its current trajectory” at all costs.

The BIA, which said there was overwhelming evidence to suggest the proposed NHI model was not the ‘best fit’ for the Bahamas, reiterated the industry’s “frustration” that the Government had consistently failed to engage in “meaningful consultation” with healthcare industry stakeholders.

In response, the BIA members - who include BISX-listed companies such as Colina Insurance Company and Family Guardian - yesterday agreed not to share their data with PricewaterhouseCoopers (PwC), the accounting firm hired by the Government to do the NHI costing study.

And they are now also refusing to sign the Non-Disclosure Agreement (NDA) governing how their data would be treated, used and kept confidential.

“In light of what has transpired to date, health insurance companies that are members of the BIA have unanimously agreed not to sign the NDA or share any data with PwC at this time,” the BIA statement said.

“Our position is based on what we perceive to be the determination of the Government to proceed on its current trajectory in spite of the clear evidence that suggests a different course of action is necessary.”

The BIA added that its members would be prepared to “reconsider” this position only if the Government showed that it was serious about “meaningful consultation” over NHI.

The insurers’ new, hardline stance will likely lead many observers to question how the Government, through PwC, can develop an accurate cost for the NHI scheme.

This goal now appears to be further away than ever, given that the private health insurance industry and its claims experience data are estimated to cover around 50 per cent of the Bahamian population.

Any NHI cost estimates will thus be based on incomplete data and information, but the BIA last night said the Government and its consultants had already indicated this was of little concern to them.

Its release recalled the December 16 meeting, organised for the private sector by the Bahamas Chamber of Commerce and Employers Confederation (BCCEC), and which was headed by the NHI Secretariat and its implementation team.

“We were surprised to learn that the NHI implementation team had already completed the costing of the NHI primary care package,” the BIA said of the meeting.

That package, which is intended to be offered to Bahamians and legal residents from April 2016, has been estimated as costing $100 million per year or $25 million per quarter (with a $6 million ‘reserve’ fund buttressing the latter).

“The Government’s NHI consultant, Mr Cercone of Sanigest, indicated that the insurance data relied upon in that costing was from 2007,” the BIA continued.

“In response to our concern that this was limited and out-of-date information, he indicated that the Government was entirely comfortable with the methods used and results, and are moving forward to implement NHI based on that information.

“It was also suggested that PwC had validated the cost estimates. The BIA notes that this was done without any consultation with the BIA or its members.”

Many will wonder how the Government can move forward with such a comprehensive reform as NHI without knowing what it will cost the Bahamian people, economy and the country.

And Tribune Business understands that the only data PwC has been provided with for its NHI costing study is for Government/public sector employees with insurance - the only hard information that the Christie administration possesses.

This newspaper also understands that a pre-condition to both the BIA, and its individual members, signing the NDA was that all sides had agreed to “meaningful consultation”.

What appears to have been ‘the final straw’ for the industry in this regard is the Government’s statement confirming that Cabinet had approved the draft NHI legislation, despite no healthcare industry stakeholders being consulted or viewing it.

Nor was the Government’s assertion that the legislation is undergoing “final revisions with stakeholders” accurate, leading the BIA to blast: “The BIA has repeatedly stated that the proposed model is inappropriate and does not suit the Bahamas.

“The pronouncements of Government representatives, the dismissive content of the response to our universal; healthcare (UHC) proposal, and the approval of the NHI legislation by Cabinet confirms that our position has been entirely ignored.

“The NHI design and implementation process is so far advanced that we believe that the requested data will not add any value to the process. The NHI implementation team and Sanigest have asserted that they are comfortable with their numbers, which they claim have been validated by PwC.”

The BIA added that the PwC costing report was likely to be ignored by the Government, especially if its findings were not favourable, given that this was how the accounting firm’s first report - warning that NHI could “seriously destabilise the public and private healthcare sectors” - had been treated.

Tribune Business understands that the key recommendations contained in the BIA’s alternative to NHI, which dealt with the reform model, pricing and way the Government was dealing with the issue, have all been rejected by the Government and its team.

“The Government is intent on creating a public insurer to provide NHI benefits,” the Association added. “The BIA has examined the reasons given for this and remains convinced that this will be another loss-making public institution that will be a burden on the Bahamian taxpayer, and will provide poor service to medical providers and the public alike.”

The proposed NDAs would have ensured the confidentiality of individual health insurers’ data; ensure that the final report was shared with them and the BIA; and that the industry would have been continually updated on NHI’s progress, and future consultations and discussions.

The companies withdrawing co-operation are: Atlantic Medical Insurance; BAF Financial & Insurance (Bahamas); Colina Insurance; Family Guardian Insurance Company; Generali Worldwide; and New Providence Life Insurance Company.