No Public Insurer To Dominate Nhi


Tribune Business Editor


The Government will not permit a single, publicly-owned insurer to manage the entire National Health Insurance (NHI) scheme, the Minister of Health has revealed.

Dr Duane Sands confirmed the Minnis administration had rejected its predecessor’s model, where the publicly-owned BahamaCare would have administered all care and benefits packages to the “exclusion” of the private health insurance sector.

Speaking after meeting with the industry last week, Dr Sands told Tribune Business: “The idea of a public insurer that is created almost to the exclusion of the existing industry is not something I support.

“I believe we are going to go down a different road. The idea that we have a single public insurer managing the entire portfolio is not going to be something we maintain. We’re going to be looking at a very different model for NHI.”

The former Christie administration launched NHI without key components of its management and governance structure being in place, with the insurance sector among these missing elements.

Its original model envisaged BahamaCare and the private health insurance underwriters operating as regulated health administrators (RHAs), offering the same benefits packages at the same price to the Bahamian public.

However, the scheme launched without either. Key details had not been agreed with the private insurance industry, while BahamaCare had not been created despite Aetna and its Bahamian partner, Family Guardian’s BahamaHealth business, being selected as its operators.

Emphasising that the new government had not abandoned the ‘public insurer’ idea, Dr Sands pledged to re-work the NHI scheme to make it much more inclusive and private sector-friendly.

He added that this would “open up opportunities for local insurers and open up opportunities for new products levied at different levels of service and price points”.

“The standard medical policy is a major medical insurance policy that gives real opportunities for services provided outside the Bahamas,” Dr Sands explained. “That comes at a significant cost.

“If we now have another product specific to the Bahamas, a product where people can choose from a menu that includes different [benefits packages], you can portion what you can afford.

“That gives opportunities for businesses that cannot afford all the benefits, but want to provide some health insurance for their employees,” he continued.

“If NHI is sold by many different companies, then you have an opportunity for people to compete on quality of service once you define what the benefits will be.”

Dr Sands said both government and insurance industry representatives left last week’s meeting with a respect for the other side, and added: “It is very much different from the tone that had been established in-country over many years in the run-up to NHI 2017.

“I think we now have an opportunity to move this thing along in partnership with a previously neglected sector... I think we recognise the value brought by the insurance industry, whether we’re talking carriers, brokers etc.

“I have noted that, unfortunately, the run-up to 2017 was not inclusive enough. We don’t expect we’re going to agree on every single item, but we definitely recognise the value and commitment the industry brings to the table,” Dr Sands said.

“That opens up some very exciting opportunities to make NHI work without dampening economic growth, without dampening the financial services sector, and which affords some flexibility. We covered a lot of ground, including concepts which have not been thought about before.”


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