The Tribune

By NATARIO McKENZIE

Tribune Business Reporter

nmckenzie@tribunemedia.net

THE National Health Insurance Authority (NHIA) yesterday said it believes it can “still manage” to expand the scheme’s medical services without any increase in premium costs.

Graham Whitmarsh, its managing director and chief executive, said the NHIA is proposing to expand benefits to include pediatric cancers without any increase in premium to cover the resulting rise in costs.

“We have decided to recommend the inclusion of pediatric cancers; children that get cancer under the age of 12,” he explained. “We think we can still manage that under the $1,000 premium that we have.

“This would add to the package of cancer care to ensure that the youngest children unfortunate enough to get these serious diseases can be treated without any co-pay or deductible, and remove any concerns the family may have around the cost of getting that treated.

“We still believe... we can include pediatric cancers partly because there are relatively few children unfortunate enough to suffer from those diseases. We did have some margin in the $1,000.”

The policy change was one of several Mr Whitmarsh outlined yesterday, with the NHIA having concluded a consultation period which began on October 23, 2018.

“The change was one that came out of a discussion with the private health industry. They had questions about how they could deliver this package of benefits for the $1,000 that we had proposed,” he said.

“We talked to them about adopting a national fee schedule for the services covered by the Standard Health Benefit. What this would mean is that the private health insurers would have access to the same pricing that we would, which would help them deliver this package for the $1,000 that we estimate it would cost.”

When asked by Tribune Business to explain how the NHIA ultimately arrived at the $1,000 premium price, Mr Whitmarsh explained: “What we did in very simple terms, we looked at each of the diseases, the population of The Bahamas, the prevalence of those diseases and, if it was a cancer, we looked at what stage they presented and what the care pathway was.

“We then looked at the cost of each one of those treatments and, in effect, said there are a certain number of people we know will get them, a certain number that will present with stage one, and we know what the cost is. We had cost data from the Public Hospitals Authority. We had to use some other data to provide cost inputs for the private sector. We benchmarked it against costs overseas to make sure that we’re in the region.”

Mr Whitmarsh added: “We’re confident there is enough money in the pool. It was a very detailed exercise we undertook with that. We are still working with the insurance industry to ensure they fully understand it. The national fee schedule came out of that because the insurance companies wanted to make sure that they were not disadvantaged. We thought it was a reasonable request where, if we are paying the PHA at a certain cost, that they should have access to the same fee schedule.”

He said the fee schedule still has to be worked out. “We have had preliminary discussions with the physicians and the insurance industry. Most of the work we have done is on the first of the cancers,” he added.

“After we have worked our way through that care pathway, we’re about to start the second one but that will take some months to bring together because we didn’t have it in our original proposal. It came out of the feedback. It’s not uncommon to have a fee schedule to these types of services in other jurisdictions, so there are other models that we can look to.”

Mr Whitmarsh said NHI beneficiaries will get access to a family doctor as many times as they need it, plus laboratory tests associated with those visits as well as diagnostic imaging. “The package of high cost care would include a package of cancers, breast, cervical, colon cancer and prostate cancer which are the major cancers in the country. We have added to that pediatric cancer. We acknowledge it’s not everything but some of the major cancers and hitting the major diseases,” he added.