The Tribune

By YOURI KEMP

Tribune Business Reporter

ykemp@tribunemedia.net

Top National Health Insurance (NHI) executives yesterday said extra government funding was required to cover the five percent monthly increase in beneficiaries, and did not represent a "cost overrun".

Dr Robin Roberts, the National Health Insurance Authority's chairman, said the almost $10m increase in the scheme's 2019-2020 government subsidy was necessary to meet the demand for services. He argued that there should be no financial restrictions or controls imposed on how often a patient can see their doctor.

Pointing out that there has been a 33 percent increase in enrolled NHI beneficiaries, from 55,000 to 73,000, Dr Roberts said: "We have been increasing at almost up to five percent per month. I think the word is out on the street that when you enroll with the NHI, first of all you get good service just to enroll.

"I would like to believe that it is the intent of the government to improve the quality of care for all Bahamians. So they will do what is needed to provide the funding to do that. I hope there is no control in that because that is the whole purpose of the capitation, such that as many times as you need to see the doctor you can go and see him.

"The good doctor will make sure that you don't need to come and see him that often because he is going to try to correct the problem right from the beginning and, more importantly, prevent it from happening again."

Graham Whitmarsh, the NHI Authority's managing director and chief executive, said the increased taxpayer subsidies for the scheme were "not a cost overrun". He explained: "The model that NHI has is a very modern method of paying for primary healthcare.

"It's a method whereby a physician comes and registers with us, and then they decide how many patients they want to have. So they may say they want a full panel of patients, which is 2,000, and then we make a payment every month to the physician based on the age, gender and geographic location. It's called a capitated payment system. What that does is it fixes the cost of primary healthcare."

"The average cost on New Providence to provide that is $15.60 per beneficiary per month, which is very cost effective," Mr Whitmarsh added. "As Dr Roberts mentioned we have seen an up to 5 percent every month increase in enrollment.

"Every time somebody enrolls, we incur an additional fee. So we have known from the beginning of the year that as our enrollment numbers go up so does our costs, so it is definitely not a cost overrun."

"About 80 percent to 85 percent of the money we spend today goes to laboratories and physicians. Our target is to have our administrative costs less than 15 percent." This, Mr Whitmarsh said, would make NHI "very competitive" with the private health insurance industry, and he expects to achieve those numbers this year.

"Every NHI beneficiary, while it's an additional cost to us, is also typically one less individual that has to use the public system," he said. "Just recently we have seen for the first time information that indicates that there has been a reduction in the number of visits at public clinics and, as you all know, they are heavily stressed and overburdened, so we believe now we are having a measurable impact on the public primary healthcare system."