Following my comments on National Health Insurance last week, Roy Barry — the deputy director of the Social Security Board with responsibility for NHI — gave a radio interview on Saturday that seemed to raise more questions than answers.

Mr. Barry stated that the number of people registered for NHI is about 36,000, but that there are temporary workers here who may not have registered, and that an unknown number of longer-term residents also may not have registered for whatever reason. It is also thought that people who do not live here, but have ties such as property or family, have also registered, presumably so that they can get cheaper treatment.

Registration is compulsory, and there is a fine of $1,000 in default. This penalty, however, has never been applied. That’s probably because the programme doesn’t know who hasn’t registered.

The figure of more than 36,000 compares with the estimated 28,000 in the 2010 census, and world estimates of 35,800 in 2018.

Registering, of course, implies contributions to the scheme by those in work and their employers, and it is thought that many are delinquent in this respect. Of course, if you don’t register you don’t get a card and will be refused treatment under the scheme when you require medical attention. Some customers have been refused reimbursement because they find that their employer has not been submitting contributions.


Programme’s finances

Government has so far not put any money into the scheme, other than to pay for “government funded” people, which includes seniors (not working), children under 18, prisoners and various government employees. The scheme has existed so far on the contributions, but is burning money fast, and will soon require a top-up from government or an increase in contribution rates. The biggest strain on the resources came because the originators of the scheme did not reckon with the instant huge rise in charges by the medical profession.

As far as I can tell, there are limits to what the scheme will pay for certain treatments, but they seem to be rather arbitrary, from limiting the number of doctors visits or scans, to funding up to $750,000 for an overseas treatment. Most private health insurances place either an annual or a lifetime limit on the cost of treatment.

In short, Mr. Barry was stumped to answer many questions and it does seem that the scheme needs a root-and-branch review.