ON THE TABLING OF THE NATIONAL HEALTH INSURANCE ACT 2006

WEDNESDAY, 15TH NOVEMBER, 2006
HOUSE OF ASSEMBLY
 

Mr. Speaker,
It is with mixed feelings that I place before Honourable Members of the House this Bill to Establish a National Health Insurance Scheme.

I say mixed feelings because it is with some measure of regret that, as a country, it has taken us so long to put in place a system of health financing that can secure lifetime access to health services for our people.
 

It is also with feelings of genuine gladness and optimism that the privilege is now mine to be the leader of a team bringing before the House this historic Bill that sets out to transform our approach to health and the welfare of our people.

Mr. Speaker,
Before I get into the objects and contents of the Bill, I want us to reflect on three aspects of this historic path, which we are carving for our country: —

Firstly, the close relation between good health and the well-being of our people;

Secondly, good health and the wealth of the nation; and

Thirdly, good health and our collective sense of responsibility and compassion.
 

(HEALTH AND WELL-BEING)
Mr. Speaker,
It is an unqualified truth that not one of us gathered here can casually assume that good health will be a permanent feature of our lives.

It is a fact that our progress in health now means that the average life expectancy of a Bahamian is about 73 years.  However, this is only an average — some may be lower, some higher.

Without good health and the means to sustain that good health, the quality of our daily life is weakened and the freedom to enjoy the fruits of our long years of toil is diminished.

I know… in fact we all know — that way too many people simply do not have the means to pay for their health care.

Some people are faced with huge bills at one time.

Many more people are faced with regular and increasingly burdensome bills to treat and manage a chronic health condition that requires continuing visits to doctors, tests and more tests; more drugs and sometimes a stay in hospital.

There are some people in our country who die because they are unable to afford the health care they need.  In the fact of that fact, what rationale can be put that in moving for National Health Insurance we are not doing the best thing for our country?

Without some form of health insurance, many people have to dip deep into their savings or borrow or depend on help and the charity of others.

Cookouts, church welfare activities; or donation sheets: all to find the cash to pay people’s health care bills.

Many who cannot get help or who don’t have the savings to draw on have to live with their pain and sickness and the shackles imposed by that sickness on their daily lives.

Many persons also, without adequate cash, live with the fear of getting sick and worry about how they will manage.

What hard choices will they have to make?  What things will they have to do without so that health care bills can be paid?

I am saying that in the 21st century Bahamas, we cannot allow so many of our people to be excluded, to lack access to care, to suffer; when we know that by pooling our resources we can do better.

We cannot leave the health of the population to individual luck or to charity.

As a caring society, as a caring government, as a country with the highest GDP per capita in the Caribbean, we can do better than to allow so many to suffer in the midst of plenty.

This is what National Health Insurance is all about — a mechanism to share the cost of care and access to the benefits of health care based on one’s need.
 

(HEALTH AND WEALTH)
Mr. Speaker,
Every well-developed and progressive society recognizes that good health in the population is the bedrock – a vital resource; a facilitating precondition for the creation and enjoyment of wealth and for individual advancement; business advancement; and indeed national advancement.

However, the growing burden of chronic diseases, the persistent threat of HIV-AIDS and the unacceptably high incidence of violence and accidents have led to major concerns over the impact on the young and our working population.

This concern is justified, because:
? Good health is essential for productivity;
? Productivity is essential for sustained production;
? Sustained production is essential for economic viability; and
? Economic viability is essential for national development.

When viewed in the context of all the major developments and the plans for future developments in The Bahamas, we need a healthy population to take advantage of the opportunities being created.

We need to find – and indeed we are finding – the resources to make the investment in health facilities and services to sustain the health of the population.

For, if I may paraphrase from another well-known source, what would it profit a business or community if it has all the gains from commercial development but the availability and quality of its health services cannot match this level of progress?
 

(HEALTH, RESPONSIBILITY AND COMPASSION)
Mr. Speaker,
Our approach to health reflects our cultural values in terms of individual and social responsibility as well as our sense of compassion.

We know that we have made significant progress in improving the health of the population.

Many of you may remember the days when polio and smallpox ravaged our children, when leprosy and typhoid fever and polio made our lives miserable from being bed-ridden and unable to carry out our daily duties; and when TB meant isolation from families and friends and almost certainly it meant an early death.

Today, many of these health scourges have been conquered.  We can now expect to live longer, our children can survive those difficult early years and the majority of our mothers do not have to face childbirth with uncertainty.

But while we have made progress in reducing or eliminating most of these health scourges, we are now faced with new health challenges.

High blood pressure, heart disease, diabetes, high blood cholesterol, cancer, depression.

These bring heart attacks, strokes, kidney failure and amputations; among a host of dire consequences.

And on top of these, we must face the spectre of HIV-AIDS and the growing burden of injury and trauma caused by accidents and inter-personal violence.

Each day, the Ministry of Health and all private health care providers have to confront thousands of cases of chronic disease; of trauma, of HIV-AIDS.

Data for 2003 reveal that about 26% of the population (1 person in 4), has high blood pressure; 17% (1 person in 6), has diabetes; 66% of the adult population (2 out of every 3 adults), are overweight or obese with all the attendant co-morbidities, and the incidence of cancer and mental illness remain at unacceptably high levels.

In addition to the human suffering, the disability and premature deaths caused by these conditions, we have to confront the cost of care.

Confronting the cost of care means:

? Having to find the funds to keep improving our facilities;
? Having to find the funds to keep up to date with securing the most effective health technologies;
? Having to find the funds to keep abreast with advances in the pharmaceutical industry and to purchase the most reliable and cost effective drugs; and finally
? Having to find the funds to train, recruit and adequately compensate our health professionals.

For all of us: individuals, business firms, health care providers; and the health authorities, there is the clear recognition that we can do better with managing our health concerns…

We can do better with how we care for our health.

More fundamentally, it takes cash to care.  Finding the cash means developing a collective solution.

The answer does not lie in a solution for only the public or private health sectors or business or private health insurance only.

A collective solution means that we must build on clear principles, on partnerships, on the shared values of Bahamian society, on blending personal and social responsibility and on good stewardship by government.

National Health Insurance offers that collective solution.

National Health Insurance is a financing mechanism that pools the resources and health risks of the community — persons contribute on the basis of their ability to pay and access care on the basis of their needs.
 

(GOAL OF NHI)
Mr. Speaker,
National Health Insurance is a plan to help all residents have ready access to health care services:
? On a timely basis;
? In a dignified manner;
? Throughout their lifetime; and
? Without having to face the financial worry and burden of having to find large amounts of money to pay for the care they need.

All residents, means:

? All ages — no one will be excluded because they are too young or too old;
? All workers, persons who are not working and pensioners;
? All income groups — the poor, the not so poor and those who have plenty.
? All health conditions – whether you are healthy or sick or disabled or have any kind of pre-existing condition.
? All those who already have private insurance and those who do not.
? All 320,000 Bahamians living in all our islands and cays.
 

(HEALTH BENEFITS PACKAGE)
As members of NHI, citizens and legal residents will have ready access to all of the following health benefits:

--Access to General Practitioner and Specialists when you need to visit a doctor;

--Prescription drugs when your doctor says you need medication;

--Laboratory tests and X-rays and other diagnostic services;

--Medical care, surgery and room and board when you need hospital care;

--Emergency transport to health facilities when needed — this is especially for persons who live in the Family Islands and who need to get quickly to the major health facilities in Freeport and Nassau;

--Access to overseas care for those services that we cannot provide in The Bahamas.

In addition, we recognize that a health plan must not only focus on ‘sickness’ but also on ‘wellness’.

We know that ‘prevention is better than cure’.  So we want to put aside some money to promote healthy living.
 

(COST OF NHI PROGRAM)
To pay for all the health services we want to provide, to undertake all the necessary tasks and activities in our health promotion programmes and in managing such a national plan, it is estimated that about $235 million per year will be needed.

To help us to meet this cost of $235 million, we will be looking at that partnership I spoke about — the joint contributions by government, workers, employers and the retired population.

To find this money, we have worked out that we will need contributions from workers and employers, the self-employed, pensioners and the government.

Workers will be asked to pay about 2.65% of their income.  This will be matched by another 2.65% from their employers for a total of 5.3% of their income.

The self-employed will pay a flat rate based on a broad estimate of their earnings per year.

On average, this will work out to about 5.3% of their earnings.

Pensioners, who have a substantial income, may also be asked to make a small contribution of 2.65% of their pension.

And the government will be required to make contributions on behalf of the poor, the disabled and on their share on behalf of public sector workers.

To give you an idea of what the expected contributions are:
? Someone like a pensioner getting $500 per month will be asked to contribute $13 per month;
? A worker earning $1,500 per month will contribute $40 and his employer $40;
? Persons earning $5000 and more per month will contribute $133 and their employers will contribute $133.

When we compared these contributions with what someone would pay for a private health plan, we think that most persons will find that NHI is very affordable.

This is much less than they would pay for the same package of benefits to a private insurer.  Indeed there is no private plan that can match the benefits package.
 

(IMPROVEMENTS IN PUBLIC HEALTH SYSTEM)
Many people have also expressed concerns that the quality and availability of services in the public health system will change to accommodate the new demands made by National Health Insurance.

Let me say that there is already a plan being implemented to bring about major improvements in public health services. This includes:

? A new hospital for Grand Bahama to replace the Rand Memorial;

? Mini-hospitals to be built in Exuma, Abaco, Eleuthera, Inagua

? New Polyclinics and health centres in Freeport, Cat Island, Grand Cay, Abaco; Rum Cay and more.

? Upgrading of other polyclinics and public health centres throughout the Family Islands and New Providence;

? Training and recruitment of more staff;

? Upgraded equipment;

? Improvements in the supply of drugs;

? A major Healthy Lifestyle Initiative so that we try to get people to think ‘prevention rather than cure’

All these changes and improvements will not happen in a year, but it is an indication of the kind of transformation in health we are looking at, to ensure that NHI brings real change.
 

(OBJECTS AND REASONS IN RELATION TO THE PROVISIONS IN THE BILL)
Mr. Speaker,
The Bill is formally entitled ‘An Act to Establish a National Health Insurance Scheme Whereunder Persons Would be Provided With A Defined Package of Health Care Services; And To Provide For Ancillary Matters’.

It contains 16 Clauses describing the purpose, objects, management, financing and governance of the Plan.

The detailed provisions relating to the administration and operations of the Plan will be presented in companion Regulations, which will be placed before the House at a later date.

> Clause 1 indicates the short title of the Bill which will now be referred to as the National Health Insurance Act.  Clause 1 also stipulates that the effective dates for implementation of various provisions of the Act will be established by the Minister assigned with responsibilities for national health insurance.

> Clause 2 provides definitions of the various terms in the Act so that there is overall consistency with provisions in the National Insurance Act as well as other relevant Acts that pertain to health matters.

> The prime objective of the Scheme is specified in Clause 3 – that is to establish a financing and purchasing mechanism to promote the health of the population and enhance their access to health services defined in the benefit package.

> The fourth Clause indicates the establishment of a new statutory body to be called the National Health Insurance Commission which will be charged with administering the Scheme.  Matters related to the composition of the Commission and guidelines for its governance are spelt out in the Schedule to the Act.

> Clause 5 describes the various functions of the Commission in its role as administrator of the Scheme and its inter-relationship with the Minister in regard to overall responsibilities for ensuring that these functions secure the interest of the public.

> The specific tasks and activities in relation to management of the inflows, outflows and investment of monies by the Commission are set out in Clause 6 dealing with the establishment of a National Health Insurance Fund.  This Clause (6) also draws on relevant provisions of the National Insurance Act in relation to the generation and use of monies by the Commission.

> Clause 7 specifies the role and periodicity (or timing) of actuarial reviews to report on the financial status of the Fund as well as the requirement that such reviews be laid before both Houses for their consideration.

>   The target members and beneficiaries of the Scheme are identified in Clause 8.
This group of members and beneficiaries includes all contributors and their dependents, that is, their spouse and children.  The group of members and beneficiaries also includes other persons such as the indigent and other prescribed persons whose membership and benefits will be secured through contributions by the government.

> Clause 9 outlines the contribution obligations of members and government on behalf of prescribed categories of persons.  The specific contribution rates – based on the principles of reasonableness, equity and progressiveness — as well as manner of payment (as is the case for contributions to the National Insurance Fund) will be defined in the companion Regulations.

> Clauses 10 and 11 define the role and scope of contractual agreements with public and private providers for the delivery of health services to members of the Scheme.  The specific terms indicating the obligations of the Commission and the health service providers will be defined in the particular contract.  In addition, Clause 11 outlines provisions for dealing with appeals by aggrieved providers.

>   In Clause 12, the payment obligations of contributors as well as the treatment of those who are non-compliant are defined.  This is done so that there is congruence with similar obligations and treatment as for National Insurance contributors.

> Matters relating to the day to day administration of the Plan by a duly appointed Chief Executive Officer and other officers are dealt with in Clause 13.  The broad terms of employment and duties of these officers are also discussed in this Clause (13).

> Clause 14 defines the options and obligations of employers who already have or are contemplating private health insurance benefits for their employees.

> Clause 15 indicates the various matters which require detailed specification in the Regulations.  Matters which require detailed specification include such as criteria for registration of providers, likely co-payments, issue of identification cards, offences, procedures for appeals) and the role of the Minister in making these Regulations as well as for placing them before both Houses for consideration.

> Clause 16 provides for amendments in the National Insurance Act to include responsibilities for the discharge of specified tasks under contract to the National Health Insurance Commission.
(NHI, PUBLIC-PRIVATE PARTNERSHIP AND NATIONAL DEVELOPMENT)
Mr. Speaker,
National Health Insurance is not just about getting more money.  It is about money as an instrument for sustained investment in the health of our people.

I say investment because too many treat the cost of providing health services as an expenditure item, as a burden.

We can all agree that investment in health, like investment in education, strengthens our human potential and brings benefits to individuals, to businesses and to the nation.

As with any other business investment where one weighs in the balance the costs and benefits or returns, National Heath Insurance forces us to think not just about the cost of providing health care to all, but also the benefits of good health.

In this sense, making that investment in the health of our people must be a conscious act of policy rather than leaving people’s health to luck or chance or to acts of charity.

National Health Insurance is not new and has had to contend with many detractors as well as cynics.

However, I am reminded of our experience with the National Insurance Board and our bitter struggle in the 1970’s against many other detractors.

Then, the purveyors of doom and gloom predicted the worst as we sought to secure this crucial safety net for all workers and their families.

Today, there are very few who doubt the national and social value of the National Insurance Board and even fewer who have not been beneficiaries of one of its various provisions.

I sincerely hope that we have learnt from that experience and can approach National Health Insurance with better understanding of its costs and benefits.

The progress that we have made as a country in almost all areas of national endeavour, with all the challenges of size, geography and resources, has been based on the uniqueness of our public and private partnerships.

Ultimately my government has responsibility for the health of the nation.

We will not shirk our responsibilities to guide and to take the leadership role in protecting the health of our people.

But while it is a responsibility of government to take the lead it is also an obligation of all parties to rise to the challenge of sustaining those health gains.

Public-private partnerships have served us well and brought progress in many areas of national action.
A similar partnership can also enhance our progress in health.

Through National Health Insurance we can build a system that is good for all, fair to all and which we can hold high as a symbol of a caring and progressive Bahamas.

? We can improve access to public & private health care;
? We can improve access to high-cost overseas care when needed;
? We can generate more money to improve the quality & timeliness of health services;
? We can share the cost among all persons so that the burden is lighter on each.
 

(CONCLUSION)
Let me conclude, as I began, with an open and sincere invitation to you to join hands and minds as we collectively chart the course for realization of this goal, this vision, this commitment of National Health Insurance as we continuously strive to enhance the health of all Bahamians.

Indeed, with National Health Insurance, we can all put into practice the maxim that health for all is good for individual welfare… is good for business progress… and it is good for national development.

Mr. Speaker,
It is the government’s intention to begin debate of this Bill on Wednesday 29th November and pass it through all of its stages in this place by Wednesday December 6th.

It is anticipated that it will be read for the first time in the Senate on Monday December 11th and debate will begin in that Chamber on Wednesday December 13th.

Thank you, Mr. Speaker.