Providenciales, TCI, November 28, 2016 -The National Health Insurance Plan (NHIP) was established in 2009 as a Social Health Insurance Plan based on contributions from employers and employees who were legally resident in the Turks and Caicos Islands.
The Turks and Caicos Islands Government is also mandated to make contributions to the plan in the following way:
- As an employer on behalf of its employees
- As a subscriber on behalf of the unemployed, indigent and ward of the state
- Transfer of funds for the management and payment of treatment abroad cost
- Transfer of funds for the payment of the monthly hospital infrastructure cost
The funds collected by the National Health Insurance Board (NHIB) from its employers and subscribers are utilized to purchase health care locally from the preferred provider (TCI Hospitals), the network of contracted private primary health care clinics and private pharmacies on behalf of and to the benefit of its registered subscribers.
The NHIB on behalf of TCIG manages the procurement of overseas treatment for the beneficiaries of the NHIP. From budget year to budget year this cost is unpredictable as it is a reflection of both the number of persons requiring tertiary level care in any given year as well as the magnitude of their problems.
The cost of healthcare by the end of April 2017 is expected to exceed the budgeted provision by $6 million dollars. It is against that background that a paper prepared by the management of the board with the full knowledge of the Board of Directors, the Ministry of Finance and the Ministry of Health was submitted to cabinet for its consideration – to conclude that there was a cover-up or misappropriation of funds discovered by the acting CEO is incorrect, irresponsible and should be dismissed as political mischief.
The facts are that the treatment abroad programme has skyrocketed in the first half of the financial year amounting to over $5 million of the cost over-run. On average four patients a day are being referred abroad of which five a week are urgent referral requiring medical evacuation via private charters and air-ambulances; at the same time the number of cancer patients has been noted to have increased significantly in the first half of the year, these factors together result in an average cost per patient of around $15,000 with some patients costing in excess of $100,000. Because the NHIB until recently operated a cash basis accounting system, costs were not booked until paid. This has now been corrected, hence the reporting of the large accounts payable balance.
A number of the more serious cases referred abroad were Turks and Caicos Islanders that were not covered by the scheme. The government takes its responsibility for the provision of its people seriously and has recently introduced changes to the NHIB regulations that would result in healthcare coverage for a wider category of patients while at the same time restricting coverage for some categories of persons which it believes should help to stabilise cost while a comprehensive review of the system is being undertaken after five years of operation.
TCIG has asked for a review of the management and corporate governance of NHIP with respect to the rising cost of overseas treatment to develop cost reduction or mitigation measures where possible without compromising care to beneficiaries of the plan. The Ministry of Health in collaboration with NHIP has already implemented several initiatives to reduce the cost of care, such as:
- Establishment of a free extended hours government primary care clinic
- Development of a new Pharmaceutical policy which would significantly lower the cost of drugs to both patients and NHIP
- Introduced an eligibility waiting time of 6 months for all new work permit applicants to the plan (effective December 1)
- Introduced a capitation on overseas care expenditure for work permit holders
The Ministry of Health will continue to implement its cost reduction strategies as outlined in the National Health Strategic Plan, the main ones of which include:
- Implementation of the pharmaceutical policy and plan
- Implementation of the Chronic Disease Action Plan
- Primary Health Care Renewal Strategy
- Development of a long term hospice care facility
- Expansion of existing and the Introduction of new tertiary level services at the hospitals based of overseas treatment care demands.
