BIA outlines concerns about NHI implementation timeline
The Bahamas Insurance Association (BIA) yesterday called once again on the National Health Insurance Authority (NHIA) to ensure its implementation timeline is realistic, and that the details in the proposed risk equalization fund do not threaten the solvency of private health insurers.
The BIA presented the information in a press release yesterday listing a number of concerns about the NHIA’s new timeline for full implementation of National Health Insurance (NHI). The BIA is concerned that NHIA will not have enough time to consult on certain aspects of its plan and then put them into action.
“It is our view that the revised timeline which seeks to harmonize the implementation date for the employer mandate may be unachievable,” the BIA release states.
“We submit that unless the NHIA is able to complete the empowering legislation and regulations, consult stakeholders on the legislative framework, finalize the national provider fee schedule and provider negotiations, complete the benefit design details, conclude the risk equalization mechanism and address its resource requirements in a timely manner, the set date will be impossible to attain.
“The NHIA’s initial policy paper established January 2021 for the expansion of the employer mandate and the grandfathered private health insurance plans. While this initial target was ambitious, it was achievable if the aforementioned actions were taken well in advance of the implementation date. It follows that the revised date of July 2020 provides less time for preparation and implementation.”
The BIA said it shares the concerns of Minister of Health Dr. Dwayne Sands regarding the true cost of NHI, adding that the goals of the NHIA must be aligned with the fiscal consolidation plans of the government.
“We implore the NHIA to revisit its funding projections to ensure that they are realistic,” the BIA release states.
“As an illustration, the anticipated revenue from reallocated value-added tax (VAT) on health insurance premiums must account for the ability of VAT registrants to claim input tax credits and the implications for government revenue.
“Furthermore, any reallocation of VAT will require the government to replace the lost revenue and implement a framework that separates certain VAT receipts from or within the Consolidated Fund.”
The BIA added that the NHIA has to finalize its framework for the risk equalization fund as it is vital to the NHI scheme.
“The finalization of this framework is essential to pave the way for an assessment of its impact on premiums and the subsequent notification of clients,” the release notes.
“The NHIA has indicated that this fund only seeks to equalize premiums and not health claims. The BIA fears that should the assumptions of the NHIA fail to hold, the solvency position of private health insurers could be severely negatively impacted.”
The BIA insisted that consideration be given to carrying out a means test so that people who can afford to contribute more, pay more, and thus the “NHIA truly focuses on the less privileged in our society”.
“The BIA takes this opportunity to restate its concern regarding the state of the public healthcare system and the changes in not only the operational structure, but also the systemic cultural changes required to ensure readiness to deliver an expanded NHI product,” the BIA states.
“The BIA remains a strategic partner with the NHIA and government in the journey to universal health coverage in The Bahamas.”