To­wards a national health in­sur­ance plan

Jamaica Gleaner - - INTERNATIONAL NEWS -

HEALTH IN­SUR­ANCE is a highly de­sir­able com­mod­ity for a ma­jor­ity of Ja­maicans. This was con­firmed by a re­cent sur­vey which found that 85 per cent of per­sons who are not now cov­ered by health in­sur­ance, would wel­come it.

The find­ings were con­tained in a Gleaner-com­mis­sioned sur­vey con­ducted by poll­ster Bill Johnson and his team in Septem­ber.

As many as 89 per cent of 1,200 re­spon­dents, ages 18 to 65 and up­wards, said the Gov­ern­ment should in­tro­duce a national health in­sur­ance plan to cover all health care and med­i­cal costs.

Con­sid­er­ing the cur­rent and future chal­lenges in health-care fi­nanc­ing and the cru­cial role that the National Health Fund (NHF) has played in sub­si­dis­ing health care, the Gov­ern­ment has man­dated the NHF to de­velop such a scheme in or­der to ar­rive at a well-funded health sec­tor that will de­liver qual­ity and timely care to the pop­u­la­tion.

“We are looking at some sort of national in­sur­ance,” con­firmed NHF Chair­man Chris Zacca. “I think out-of-pocket pay­ment at point-of-care is an ob­sta­cle to ac­cess in Ja­maica, so an­other way to tackle it is to cre­ate an in­sur­ance pool of funds which would rep­re­sent al­most a free pay­ment for ser­vice, and I think this will be more man­age­able go­ing for­ward.”

He was quick to point out that dis­cus­sions were merely at the pre­lim­i­nary stage. Added to the fact that leg­isla­tive changes will be nec­es­sary, such re­form could be years away.

Yet, the NHF chair­man was cer­tain that in or­der to achieve the univer­sal health-care goals man­dated by the United Na­tions and its agen­cies, it was im­per­a­tive that a big­ger pool of funds be sourced to sup­port the health sys­tem.

How big a pool? Wayne Chen, chair­man of the South­ern Re­gional Health Au­thor­ity, re­called that a study done many years ago con­cluded that the cheap­est health in­sur­ance for a pop­u­la­tion of 2.7 mil­lion was around $41 bil­lion a year.

Mean­while, Ali­cia Fos­ter, vice-pres­i­dent of Guardian Life In­sur­ance, threw out some sober­ing fig­ures. She es­ti­mates that only 16 per cent to 20 per cent of the pop­u­la­tion has pri­vate health in­sur­ance. And

FOS­TER

be­tween the two ma­jor providers, an­nu­alised pre­mi­ums range be­tween $12 bil­lion and $13 bil­lion.

“It is not a very lu­cra­tive busi­ness in Ja­maica,” de­clared Fos­ter. “We are ba­si­cally pay­ing out 80 per cent – 85 per cent of the pre­mium as claims and then you have your ex­penses to cover, in terms of your mid­dle­men. Then you have your bro­kers and your op­er­at­ing ex­penses.”

THE COST FAC­TOR

There is al­ready pri­vate-pub­lic par­tic­i­pa­tion in health, in­clud­ing pri­vate phar­ma­cies and var­i­ous foun­da­tions, and or­gan­i­sa­tions which make con­tri­bu­tions to the coun­try’s health-care sys­tem. But it is not enough.

Can pri­vate health in­sur­ers in­crease the sale of their in­volve­ment to strengthen this part­ner­ship? Cit­ing the cost fac­tor, Fos­ter said that pri­vate in­sur­ers op­er­ate to pro­vide a re­turn on share­hold­ers’ in­vest­ment. “If you are in­sur­ing the en­tire pop­u­la­tion you have the law of large num­bers, so you would be able to of­fer pre­mi­ums that are more or less af­ford­able. But there has to be some sys­tem that en­sures ev­ery­one comes un­der that um­brella and, un­for­tu­nately, un­less it is man­dated, it is not likely that ev­ery­one would.”

Risk manager and ac­tu­ary Brita Hay had the an­swer to that ar­gu­ment, in­sist­ing that the part­ner­ship dis­cus­sions can­not take place with­out the req­ui­site data to es­tab­lish who cur­rently has cov­er­age.

“Some per­sons have two health in­sur­ances, one from their employment and the other from their spouses’ employment, yet these per­sons also avail them­selves of free health care un­der the Gov­ern­ment’s no-user pol­icy.”

Hay kept ham­mer­ing away at this point as she called for an in­te­gra­tion of all data­bases as a first step in de­sign­ing a national in­sur­ance health sys­tem.

For her part, Mrs Fos­ter won­dered whether the pub­lic health sys­tem was equipped to de­liver ser­vice to the en­tire pop­u­la­tion. “I think there would need to be some kind of re­form in how they ap­proach things.” She cited the lack of ef­fi­ciency in col­lec­tions and wastage as two ar­eas that would re­quire se­ri­ous at­ten­tion.

She con­tin­ued: “To have sys­tems that run ef­fi­ciently and en­sure that the touch­points are all cap­tured, you need to have an in­te­grated frame­work not just for col­lec­tions and who should be cov­ered, but also pa­tient records and pa­tient sys­tems ... and those have a heavy cost.”

CHEN

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