On June 7, The BVI Beacon turned 40. To celebrate, it is re-publishing some of the biggest stories from its archives over the past four decades. The article below was written by Ken Silva which originally ran Jan. 7, 2016
As promised by government, the National Health Insurance system kicked off at the start of the New Year, providing coverage for the more than 25,500 residents who had registered as of Monday.
NHI officials celebrated the launch as an “historic” step toward ensuring quality and equitable health care for the entire population, but others are reserving their judgment on the programme until they see it in action.
Meanwhile, the NHI Concerned Citizens and Residents Group said last Thursday that their concerns have not been adequately addressed, and they promised to continue to oppose the programme.
Private plans
Health and Social Development Minister Ronnie Skelton touted the launch in a statement released Monday.
“We take great pride in this achievement of universal health coverage, upholding the 1948 World Health Organisation Constitution and other international instruments that declare health a fundamental human right,” he said.
Mr. Skelton also touched on topics that leaders didn’t address in the months leading up to the launch, including what firm will provide reinsurance for the NHI programme and how administrators will handle cases that require preauthorisation to be transferred overseas.
After receiving three tenders, he said, the government has contracted Caribbean Insurance (Health) Limited to provide reinsurance coverage for catastrophic claims over $250,000.
Mr. Skelton added that overseas claims requiring preauthorisation will be handled by an NHI medical director, who will consult with the patient’s referring physician and the overseas specialist to whom the case is being referred.
A medical review committee was originally expected to handle such claims, but Mr. Skelton said leaders decided instead to appoint a single director “after consideration of public concerns and widespread misinformation.”
Other NHI information may come soon, including actuarial studies that project what the programme will cost over the next 20 years.
Though officials have previously declined to provide the studies to the public, Mr. Skelton said that he will “be seeking authorisation from the Cabinet to table these reports in the House of Assembly.”
He added that the reports show that NHI is sustainable in the long term.
Waiting to see
Not everyone is as confident about the programme as Mr. Skelton. Some residents and businesses cancelled their private coverage this month, but others are maintaining their plans while they “see how [NHI] works out,” according to Nagico Insurances executive Sarah Hatcher, who is also the president of the Insurance Association of the BVI.
Other residents have transitioned from their full-coverage private plans to supplementary packages now offered by Nagico and other insurers, she added.
Though Ms. Hatcher said she didn’t know off the top of her head exactly how many people have cancelled their private plans with Nagico, she said that enough have maintained their coverage that the company has not yet had to lay off any staff – something the private insurance industry said last year that it expected to have to do.
“We do not expect to make layoffs this month or next month, but will need to review the situation after that depending upon how many firms cancel their policies,” Ms. Hatcher explained.
Providers’ perspective
Two health care providers also told this reporter that they’re reserving judgement on NHI until they see how easily they’re able to get reimbursed for their customers’ claims.
“The first thing we have to do is see how it works,” said B&F Medical Complex owner Alred Frett. “Right now, we’re keeping a record of what services we provide, and we’re going to approach them about receiving reimbursement.”
Mr. Frett said he’s planning to meet with NHI officials today or tomorrow to discuss how the claims system will work.
Similarly, Therapy Works owner Dr. Jerry Smith said his practice is waiting until the end of the week to process claims.
Dr. Smith said the biggest challenge so far has been providing benefits to patients who haven’t completed the NHI registration process. He said his office has had to manually verify with NHI officials that those patients are indeed being registered under the new system.
The doctor added that he expects that there will be hiccups in the system at the beginning, but that in the long run they will be ironed out.
“With something as robust as this, you’re going to have your problems at the beginning,” he said. “But as long as I’m not broke in March, I’m good.”
Meanwhile, residents receiving treatment under NHI have begun to leave feedback about their experiences on Facebook and other forums.
On BVI Community Board, for example, Mel Lewis said she had a $1,000 procedure done at a dental clinic. Under her private plan she would have had to make a $500 co-payment, she wrote, but “now with NHI, it’ll just be over $100.”
However, on the same forum, Khadijah Smith reported that NHI had proved more expensive for her.
“I did an ultrasound yesterday,” Ms. Smith stated. “My bill was $425 and my co-pay was $235 with NHI. With my former insurance, I used to pay $115, so I’m a bit concerned.”
Opponents
While patients begin to collect benefits and providers figure out the claims system, a group of residents who have opposed NHI throughout much of 2015 continues to speak out against the programme.
Members of the NHI Concerned Citizens and Residents Group met with Premier Dr. Orlando Smith in October to air grievances and present alternatives to NHI.
Dr. Smith issued a written response to the group’s presentation last month, but the group said in a Dec. 31 press release that they were not satisfied.
“We were disheartened by the premier’s vague statement,” the press release states.
The group also released the premier’s full letter, which states that government reviewed and will be taking your suggestions into consideration wherever possible.”
But the premier’s eight-sentence response, which is dated Dec. 22, does not state what, if any, changes might be made to NHI, an omission that left the citizens group “deeply disappointed.”
The group promised to continue to oppose NHI, and said it’s considering various options to challenge the health care plan via political and legal means.
“We have upped the ante by soliciting the intervention of the United Kingdom’s Foreign and Commonwealth Office,” the press release states, “and we are considering other options, including legal challenges and political action.”