By NEIL HARTNELL
Tribune Business Editor
nhartnell@tribunemedia.net
Doctors and private health insurers yesterday appeared to be caught off-guard by the Government’s tabling of National Health Insurance (NHI) reforms in the House of Assembly, with one saying: “The devil’s in the details.”
Dr Michael Darville, minister of health and wellness, in tabling the NHI Bill 2022 for its first reading indicated that it “will lay the foundation for the launch of catastrophic care coverage” by providing the legal framework for the roll-out of its Standard Health Benefit package.
Private health insurers will be mandated by the legislation, if passed by Parliament, to offer this product as their “minimum standard of coverage” in terms of the medical services that are covered. The Bill stipulates that these must include primary health care services; health education and promotion; early detection and preventative care; diagnostic imaging; paediatric and maternity care; and screening initiatives for cancer and other “specified conditions’.
Dr Duane Sands, former minister of health and current FNM chairman, who was still trying to obtain a copy of the Bill when contacted by Tribune Business, said that the question of who pays for the expanded coverage - and how much - were likely to resurface again as they have been a recurring theme during NHI’s existence.
Confirming that the Standard Health Benefit has been “a concept that has been floating around” ever since the consultants, Sanigest Internacional, produced their NHI report for the Christie administration almost one decade ago, Dr Sands said: “The devil is in the detail. On the face of it, let’s see how this advances us on the path to primary care.
“Second, how are they going to pay for it? There have been discussions about co-opting some of those premium dollars from private health insurance to pay for that particular area, the Government will pay some and so forth.” While the Standard Health Benefit already exists, Dr Sands added: “The Government is now going to define what that is, and ultimately this is going to be a case where everybody has the Standard Health Benefit.”
Insurers and doctors appeared to be blindsided by the Government’s tabling of the NHI Bill in the House of Assembly, although Dr Darville made clear further consultation will take place with all stakeholders. Tribune Business was told that members of the Medical Association of the Bahamas (MAB) had been due to meet last night to discuss the Bill unaware that it was to be publicly unveiled.
One doctor, speaking on condition of anonymity, said: “I know it was up for discussion. The insurance industry has been in discussions with the Government for over 12 months on this legislation, I understand, and the Government just reached out to the MAB to have an initial presentation and meeting with them.
“That was about October 6. In that meeting there were lots of questions and concerns raised after the presentation, and we have another meeting tonight [last night] with the Association to discuss further what our recommendations and suggestions will be with the legislation. What it appears as if the Government is doing is forcing the hand of insurers to provide a national health benefit package to all Bahamians.”
Dr Darville, in his House of Assembly presentation, confirmed: “All private insurers that offer health insurance plans in the country will be required to offer the newly-purposed Standard Health Benefit package as a minimum standard of coverage.
“In this sense, the NHI Authority will assume the role of the insurer of last resort and will protect our poorest and most under-served communities. The impacts of country-wide healthcare coverage cannot be understated and our administration made a commitment to the Bahamian people and we continue the journey we started in 2016.’
In a bid to “reduce duplication and unnecessary spending in our healthcare sector, individuals with private insurance coverage will receive the Standard Health Benefit through their private insurance plans and therefore be ineligible for coverage under the NHI programme”, Dr Darville added.
“I want to be clear that those eligible for coverage from the NHI Authority must not be a recipient of private health insurance coverage. But make no mistake. If, for whatever reason, an individual loses their private insurance coverage, NHI Authority will step in as their primary insurer and ensure they have continued access to primary care services under the Standard Health Benefit.”
Promising consultation with healthcare providers, insurers and the business community, Dr Darville said some 135,000 persons have enrolled in NHI with patient satisfaction ratings said to be “well over 90 percent”.
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