The National Health Insurance (NHI), controversially implemented by the previous National Democratic Party (NDP) administration in 2016 is on the brink of a serious overhaul, as the subject Minister has hinted a “war” on the policy.
Acting Premier and Minister for Health and Social Development Honourable Carvin Malone (AL) said some hard decisions have to be made to make the scheme in the Virgin Islands more effective.
‘Major issues’ with NHI- Hon Malone
Given a few minutes to give remarks at the Town Hall Meeting call by Minister for Natural Resources, Labour and Immigration, Honourable Vincent O. Wheatley (R9) at the Catholic Community Centre in Virgin Gorda on January 23, 2020, Hon Malone remarked that NHI has become unsustainable and "some hard decisions have to be made.”
"We have some major issues,” Hon Malone added, noting that stronger attention will be given to address the issues with NHI when the war on derelicts [vehicles & boats] is won.
He also said he has not been able to identify any jurisdiction that is void of NHI and NHS issues.
"It’s well intended but we have to find out what that intent was. We have to find out where we would like to take this in a sustainable manner, how best we can do this so that when you need the services, of the National Health Insurance, that you can gain from this."
According to the Health Minister, many suggestions are already on record and he has started the data collection processes and has been able to finger some of the issues.
36,000 registered with NHI
Hon Malone stated that NHI has some 36, 000 registered and government continues the policy of having free health care services for persons ages 1 day to 18 years and free services for seniors 65 years and older.
Similarly health care services are enjoyed free of cost by Fire and Rescue officers, police officers, prisoners, prison officers and indigent persons.
“It’s being paid for by persons between the ages of 18 years and 64 years 11 months and 29 days. Until you reach your 65th birthday we want your money, we want to be able to get this done," said Hon Malone.
A major challenge
One of the sore challenges; however, according to the Minister, is that the local public health facilities cannot bill those persons in the non-paying bracket.
"That's fine, the government contributes about $42M to take care of the hospital administration and health care for all these persons. But most persons have their private doctor. They say they don’t want to go to Peebles or they don’t want to go to Iris O'Neal (Health Centre) they want to go to a private doctor."
"So although government is paying for all these services we have to pay it twice, because when they go to a private institution then they have to get the 10% co pay, and we have 90 cents on every dollar that NHI has to pay again, so government in that case is paying twice for those services for those persons who have free health care."
This, the Health Minister said, is unsustainable.
NHI spends more than it earns
It was in 2018 that Director of the Virgin Islands' (VI) Social Security Board (SSB), Ms Antoinette Skelton told the House of Assembly’s Standing Finance Committee to examine the draft allocations for 2018 that NHI was spending more than it was earning.
NHI in 2017 earned $79,882,819 but its total expenditure was $80,476,662. This represented a net loss (deficit) of $646,843 that year.
Another challenge, Hon Malone also highlighted, is the ability of private institutions charging for health care services higher than the public health services can.
Residents heard that communities would be given the opportunity to make their input in efforts to help the sitting government fix the flaws with NHI and health care in the Territory.