The National Health Insurance (NHI) has been operating at a loss and Members of the House of Assembly got a first-hand information about the challenges during the Standing Finance Committee (SFC) meeting.
Roy Barry, Deputy Director, Social Security Board, NHI, explained that as of 31 October a total of 38,062 persons were active with NHI and from the period January to October 2019, there were a total of 2,359 new registrants.
In disclosing the matter of the deficit he told the legislators that for the period that ended on October 31 the NHI revenue amounted to $73.03M and incurred expenditure totalling $79.49M, resulting in a net operating deficit of $6.46M.
Highlighting how NHI was losing money, Barry informed the SFC that a total of $35.20 million was paid out for claims. It was noted that claims directly from Central Government to Health Services Authority was $35M. Further, it was noted that the fee incurred for repricing of claims was $848,000.
According to Barry, NHI has unpaid claims in the amount of $4.15M.
Aside from the cost of claims the organization still has operational expenses to cover. In this regard it was noted that NHI’s administrative cost amounted to $1.36M and General Expenses amounted to $3.11M.
With all of the expenses it was pointed out that NHI’s major source of funding were from premiums collected, reinsurance refund and SSB employment injury refund.
Barry told the Legislators that NHI continued to face numerous challenges that must be addressed to ensure sustainability. These challenges included the occurrence of several patients visiting the same doctor for the same diagnosis more than three times within a thirty-day period.
It was noted that some of the blame for the situation NHI is facing falls on doctors who it was said were prescribing the higher cost medications to patients. Similarly, it was explained that doctor visits have become costly even with NHI subsidy.
“Balancing Bill Health care should have become more affordable with the advent of NHI but with balance billing, the out of pocket cost is exorbitant and often deters persons from seeking needed medical care,” Barry explained.
An alarming disclosure was the fact that the government was paying twice for healthcare services. In explaining the situation Barry said. “Government registrants (children, prisoners, persons over 65) are allowed to access care at private facilities while NHI collects no premium on behalf of this specific group.
Government is expected to contribute on their behalf, but instead a subvention is forwarded to Health Service Authority through NHI in the amount of $42M annually.
A review of the system revealed that in 2018, the Government-funded group incurred claims in the amount of $18.2M.
"The country is paying twice – first through the $42M to the Health Services Authority and second through NHI,” it was pointed out.
Another issue was the fact that persons who arrive in the Territory are able to commence use of NHI almost immediately. “Persons migrate to the Territory and once registered within one month have immediate access to NHI. He stated that this was a burning issue that needed to be rectified.”
Barry stated that an actuarial review was completed covering 2016 and 2017 and as a result, several amendments were recommended to the Ministry of Health and Social Development, but to date the Ministry has not implemented any of the recommendations.
Additionally, it was mentioned that legislation changes have been recommended as a means of saving NHI.
The amendments proposed are intended to strengthen NHI and reduce the abuse of the system. These include changes to the benefits package, provider contact and policy.
Barry stated that for NHI to be sustainable, Government must be prepared to submit contributions on behalf of the Government-funded group or mandate that they seek care in the public facilities.
One of the recommendations that was considered to save NHI was making it mandatory for persons to use the insurance at public facilities.
However, the idea was discarded.
In rubbishing the idea Barry said, “Currently, it states that persons had freedom of choice whether private or public. Secondly, to ask or demand a person to access care at the public facilities, we first have to create a facility that could offer the level of care that is offered by the private facilities and if this is done then NHI would be much more sustainable.”