Fri | Sep 22, 2017

Towards a national health insurance plan

Published:Friday | November 25, 2016 | 11:00 AM
Alicia Foster
Wayne Chen
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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 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."