The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

IT IS likely to be months before primary healthcare services are offered to Bahamians through National Health Insurance (NHI), government consultants from KPMG suggested yesterday, confirming expectations that this phase of the Christie administration’s scheme will not come on stream next month as planned.

Despite this, KPMG affirmed the wisdom of much of the Christie administration’s NHI plans, including its controversial decision to concentrate on providing Bahamians with primary healthcare services initially rather than with catastrophic care services.

The consultants also affirmed the government’s estimate that the services will cost about $100 million initially and to propose the creation of a public healthcare insurer.

The consultants were hired to review the plans after the government experienced significant oppostion from stakeholders who threatened not to support its NHI scheme as they felt shut out of the decision-making process because of poor consultation and a lack of information.

Top KPMG executive Mark Britnell and his team did not speak about some elements of the government’s NHI plan that have attracted significant attention however, such as its proposed comprehensive vital benefits package - the second phase of NHI which many believe will be funded through tax hikes.

Asked if KPMG made recommendations to the government concerning how it will fund the vital benefits package, Peter Deveaux-Isaacs, permanent secretary of the NHI Secretariat, said this has not been part of the scope of KPMG’s review.

The consultants’ most significant recommendation was to propose that the public healthcare insurer be managed by a third party private company as opposed to the government as originally planned.

A final determination has not yet been made on what legislative framework must exist to facilitate the public healthcare insurer, but Mr Deveaux-Isaacs said Cabinet agreed to this recommendation yesterday and will immediately go out to tender seeking a private company to manage the public healthcare insurer.

This process will take months, Mr Britnell said, adding that it must be completed and the public health insurer must be established before primary healthcare services could be offered through NHI.

KPMG was critical of the government’s process of engaging stakeholders on NHI.

As consequence, the consultants recommended an engagement process that would allow stakeholders to play a more active role.

“We have heard significant stakeholder concerns in the way consultations have been carried out and communication has been somewhat haphazard,” Mr Britnell said. “We have recommended today and the Prime Minister has accepted a new form of governance for NHI and universal healthcare.”

Without divulging details, he said: “Instead of old-fashioned notions of engagements implying a degree of passivity where government serves ideas and stakeholders volley back, we want a new programme board to be established. Four positions will be offered to the medical profession, Chamber of Commerce, the Christian faiths and the trade unions. These four groups will sit formally in a new governing structure, which will develop NHI and universal healthcare.

“We are recommending five work streams that range from workforce to the creation of the public insurer all the way through to financing and funding, including information and technology and health systems strengthening. The board would be chaired by the permanent secretary. It will speed up the effectiveness of decision making.

“Each decision is somewhat dependent on another. You can’t have universal healthcare without a public insurer; can’t have a public insurer without a payment system; can’t have a payment system without funds …The body will be rolled out in a matter of weeks.”

Officials were unable to give specific dates for when consultations on the NHI legislation and regulations will be complete, and were therefore unable to say when the NHI draft bill will be brought to Parliament and debated.

Ultimately, Mr Britnell praised the government’s NHI plans.

“Universal health care is a marathon, not a sprint. It takes many years, often decades to create a fully functioning universal healthcare system … I studied all of the countries that have developed universal healthcare and it may surprise people to know that the quickest this has ever been achieved is from South Korea in 2012.

“Most countries take at least 20 years … We have concluded that there is always more to be done but this government is making good progress in the development of universal healthcare.”