Skelton, while appearing on the Umoja radio show this week, said he doesn’t know the exact problem with the scheme, but argued that he could guess what some of the issues were.

Under current NHI regulations, persons exempted from making NHI contributions include persons 65 years or older, indigent persons, dependent children, wards of the state, risk officers (such as police, Customs, Immigration, and firefighters) prisoners, and persons qualifying under the UK/BVI Reciprocal Health Agreement signed in 1989.

Skelton, who was the Health Minister in a previous government when NHI was introduced, argued that this is a cost that was taken into consideration when the programme began and he said the government had already understood this when it was first implemented.

“The government had to take on that cost and they were doing it, they know they had to do it. Now, they have subsequent governments believe that NHI is a burden. If you think that’s a burden, try not having it,” Skelton said.

The PVIM leader suggested there has been a pattern with governments over the years, where systems are abused because governments have operated as if they are not required to pay for services it uses.

“I am not just talking about this government,” Skelton argued. “Governments believe that they burn electricity and electricity is free, that there’s no cost to it so they don’t pay the electricity department, they don’t pay the water department for the water they use. Systems cannot exist with that kind of thinking.”

According to Skelton, the NHI scheme was studied for more than five years before it was introduced and was implemented on a principle of solidarity.

Skelton further argued, that if private entities continue to carry up their rates beyond what the NHI system was designed to accommodate and provide coverage for, then that cost burden will be left on the patient.

A broken system

Deputy Director of the NHI, Roy Barry, previously said the entity is mired in a state of financial distress, a theme that has been echoed by the current CEO of the BVI Health Services Authority (BVIHSA), Dr June Samuel. He also blamed private healthcare facilities for the high copayment fees seen by NHI users.

Appearing before the Standing Finance Committee (SFC) in late 2021, Barry said the distress is as a result of having to pay for government-funded individuals (persons whose medical insurance is funded by the government) when they access healthcare at private facilities even though the NHI is not receiving monies for their care.

Part of the challenge, he explained, was that the NHI does not have the authority to mandate where government-funded individuals seek medical care even as many access services from private facilities, whether locally or overseas, and NHI is responsible for paying for the services received.

NHI currently receives an annual government subvention of $42 million which is transferred to BVIHSA with the intent to pay for services for government-funded individuals.