The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The proposed National Health Insurance (NHI) scheme has put the Bahamas “in a privileged position” of being able to “leapfrog” rival jurisdictions on implementing universal health coverage, the Government’s advisers said yesterday.

Dr David Price, a Canadian healthcare expert who is assisting the NHI Secretariat and its consultants, the KPMG accounting firm, said the planned scheme was “particularly” impressive because it was designed specifically for the Bahamas’ needs.

“What’s wonderful about what the Bahamas is doing, combining this with years of statistical-based evidence, is that it can leapfrog other countries, and use best evidence from around the globe to implement it properly,” Dr Price told Tribune Business.

“That’s what’s impressive about the model here. Nobody said we’re going to implement the New Zealand, the UK, the Canadian model. They’re taking what has been the evidence from around the world, and are contextualising it in the context of the Bahamas.

“Every country has cultural-specific needs, and that’s what the group have been very wise about.”

Dr Price, who chairs the Department of Family Medicine at Canada’s McMaster University, also serves as a key adviser to the Ontario government on primary care, and helps negotiates its service agreements with physicians.

In an exclusive interview with Tribune Business, he and other NHI advisers emphasised that it was “a fundamental mandate” for any government that it ensure its citizens had access to good quality healthcare.

“It’s what the United Nations is saying, it’s what the World Health Organisation (WHO) is saying,” Dr Price added.

“How you do that is in a Bahamian context, rather than a Canadian context. It’s really refreshing to see them expend so much effort to understand the Bahamian context, and make it [NHI] fit it, rather than the other way around, which is what I see so often.”

He explained that by combining evidence and “best practices” from other jurisdictions that have already implemented universal health coverage (UHC) system, the Bahamas had a chance to avoid many of their mistakes.

Dr Price was backed by Adrian Hamilton, a Bahamas-based management consulting director for KPMG, who told Tribune Business: “We’re in a privileged position here as we can leapfrog some of the challenges other health systems have had, and trying to do it in a Bahamian context.”

The Government’s NHI advisers were speaking amid continuing healthcare industry concerns and uncertainties surrounding the proposed scheme, including the implementation timeline and the numerous components and details that have yet to be finalised.

No specific dates for the introduction of NHI’s $100 million primary care phase, and the steps leading up to this, were provided yesterday when the issue was raised by Tribune Business.

Mr Hamilton said the registration process for physicians who will provide services under NHI will begin within the next few weeks, running parallel to the enrolment of Bahamians through the National Insurance Board (NIB) ‘smart card’ process.

Simon Townend, the Bahamas-based head of KPMG’s Caribbean advisory practice, added: “There’s a relatively short-term plan in place with dates for the roll-out. We are working to a relatively short-term plan.

“In terms of NHI and the roll-out, it’s almost as if the car has been built. It’s just a matter of turning the key.

“This is not something that is unique to the Bahamas. The actual concept of universal health coverage has been bought into by the whole world.”

Many Bahamians, both inside and outside the healthcare industry, fear the design and implementation of NHI is being rushed, given that it is likely to be a major part of the Government’s re-election bid within the next four-five months.

And while many in the Bahamian healthcare industry, including the Medical Association of the Bahamas (MAB) and the private insurance industry, have backed the concept of UHC in the Bahamas, they are opposed to the ‘how’ and the Government’s chosen method of implementation- NHI.

Mr Townend, though, argued that healthcare reform was essential for the Bahamas’ national well-being, pointing to the fact that 200,000 Bahamians - more than half the population - have no private insurance coverage, providing reason enough by itself to justify the Government’s move.

The ‘NHI Road Map Overview’ report, obtained by Tribune Business, estimated that some 100,000 Bahamians “have no financial protection at the point of illness”.

It added: “Approximately 20,000 Bahamians each year have more than 25 per cent of their household income spent on healthcare. This is roughly five times higher than in the UK, and higher than even the US.

“Analysing private health insurance policies reveals that for an average Bahamian, earning roughly $25,000 a year, they would have to spend more than 10 per cent of their annual income to purchase a health insurance policy to cover their family against financial risk due to illness.”

The NHI report described private health insurance policies in the Bahamas as “amongst the most expensive in the world”, while excluding many pre-existing conditions.

It also argued that many Bahamians were unable to use their private insurance policies because they could not afford the deductibles and co-payments.