As plans move forward to implement the National Health Insurance (NHI) in January, with registration commencing in September – some residents maintain the view that NHI should not be mandatory.
In 2013, during a series of public meetings residents called on Government to revisit the NHI proposal on the basis that the proposed scheme is being imposed on people who have health insurance and on employers who already offer insurance. Two years later, efforts to implement NHI are taking shape, but apparently some concerns of the public remain the same.
During the Umoja radio program on 20 August, members of the public expressed their concerns to a panel that included Roy Barry, Deputy Director for Social Security Board, with the Responsibility for National Health Insurance; Norma Benjamin, Manager of Referrals and Health Services in the National Health Insurance Division; and Kishma Baronville, Manager of Beneficiary and Advisory Services in the National Health Insurance Division.
Chief among the issues were concerns about confidentiality, the inability to seek care outside of the BVI, the mandatory nature of NHI, and the perception that many may not be able to afford additional coverage.
Limited to the BVI
One resident enquired whether she would be able to use NHI for her annual medical checkups with her doctor in Puerto Rico, but was told that annual checkups are limited to the BVI.
The resident further enquired: “In the case of me wanting to see my doctor in Puerto Rico what would I have to do for my annual physical, because with my current insurance I have that freedom. With having NHI, I am going to have two insurances; and that is deducting more money from my pay. If the Government is providing this mandatory healthcare system then I would like to know if I would have the same freedom as my private insurance, with my public insurance? Would the NHI work with private doctors as well or just the hospital or the clinics?”
In response, Mr. Barry said: “We can’t prevent you from having your annual physical wherever you want to go. How the system is designed, we realize that we can’t offer all the care here in the Territory. Whatever care cannot be offered here in the Territory that individual will be referred overseas to access the said care. For all service that is offered locally it is preferred that that service is accessed in the BVI. We are working with both private and public providers.”
In fact, Mr. Barry clarified that patients wishing to seek care in Puerto Rico will have to pay for it out of their pocket. For persons living in the BVI but residing elsewhere it was stated that they would have to pay for NHI because this is where they earn their income.
Callers mentioned the issue of confidentiality repeatedly. The first resident that brought up that concern asked: “We are in a small community and things that should be confidential are often not confidential. I think NHI needs to bear in mind that some people already have relationships with doctors overseas who know their history, and would have had a history with these patients. The reason why they went away is because they do not feel comfortable.”
The caller suggested that NHI at least pay a percent of the cost to travel to see the doctors overseas, and not just tell the patients that they have to see the doctors here. She also asked: “Can all the doctors that are here actually absorb all the confidentiality for the entire population of the BVI. Seriously did we consider all of these factors before telling people that this is what you’re going to do?”
In response, Mr. Barry said: “What can be done also is that the individual can submit a claim once they have returned to the Territory, and we will look at it using our customary rates that we would pay for such a service here in the BVI.”
However, the answer did not seem to convince the woman: “I don’t feel comfortable with the doctors here, and now I am being forced to go to the doctors here; and I think it is a very unfortunate event. Now we are being forced to pay for something that we don’t really feel comfortable with; and we don’t have the information to make informed decisions, because they are not bringing the information to the public.”
Another member of the panel explained that the health care system in the Territory is constantly being improved, and she said that she hopes the population would begin to feel more comfortable: “We hope that with all the improvements that are being done, you would become more comfortable to stay here at home and receive healthcare services; because the healthcare providers are really trying. We are trying too from our end to ensure that the population becomes comfortable with the services and the confidentiality because we do respect your right as an individual to privacy,” Ms. Benjamin pointed out.
Nonetheless, the confidentiality concern was raised once more by another individual who called in and said: “Confidentiality is on a lot of people’s mind. We live in a small community, and many people receive overseas healthcare because of confidentiality not only for better healthcare. What are the precautions, or what would happen here? Have you spoken about confidentiality? What would be in play? So, that individuals can be much at ease and comfortable in seeking local care?”
Mr. Barry in turn divulged that providers would be held accountable via service standards: “We are going to have some quality standards in place so that the providers will follow, and once there is a breach of those standards that provider will be penalized.”
Other Countries Re-evaluating similar system
The same resident announced that some countries that have similar schemes and have encountered issues had to engage in a re-evaluation of their national insurance: “Places like Canada and the UK have the same type of system that we have. They are now re-evaluating what they are doing, because there are people who are signed up for surgery for years and can’t get the surgery date that they need because of the system that they have which is what we are signing up for,” the caller announced.
However, Mr. Barry allayed the concerns by noting that there were stipulations in those systems that do not apply here, and hence there should not be similar glitches: “There is a slight difference in their system because each person in the UK normally accesses care within the District that they are living in. Here, we can access service in any part of the BVI. That is why they have that long list because they have to go in the District they are living,” he explained.
Too Fast, and Little Information
Despite all that is being said many are still of the belief that the NHI is being rushed and a caller communicated that thought to the panel. The resident said: “I am for this health insurance, but I feel like it is being pushed on us too fast certain questions are being answered as we go along trying to implement.”
Another caller lamented that the information on the system was not coming, as it should: “I have been monitoring the website, the same website that they say has all the information that we need and I still don’t know who the providers are. Who are the providers, and why should we have to wait until September 1, October 1, November 1 for this information. I fail to believe that every single local provider has not signed on the dotted line to say they will move forward with this. The website is there whoever said yes put it there. At least we’ll know the information is forth coming, but for you to withhold the whole list until the eleventh hour is unfair to us the public because you already told me it’s mandatory, let me know who I am working with.”
In response, it was explained that discussion; and negotiation with the local providers were ongoing. Nonetheless, Ms. Baronville said that steps would be taken to release more information.
Another resident enquired whether there were consideration of the effects that NHI will have on people. In response, the team said: “We have considered and are still considering, and that is why improvements are being made as we go along.”
In the end one must also keep in mind that BVI based, BVI-linked health care insurers have much at stake if the NHI is successful, a senior citizen told The Island Sun. “They had no competition for decades, and charged fancy sums, now government is doing the right thing by stepping in; of course, there will be glitches, but ‘something’ is better than nothing,” he said.