TCI: Opinion Piece – NHIB Spending

#TurksandCaicos, February 3, 2018 – Providenciales – Who is the Man?  As a lawyer, I regularly read the Gazette when published on Fridays as it contains valuable information for my legal practice.  Last week I read with great interest the changes in portfolios of Ministers specifically the Minister of Finance and Premier, and the Minister of Health, Human Services and Agriculture, which are to commence on February 1^st 2018.

Reader, I urge that you walk with me as we take a trip down memory lane.  Some 13 months ago, the first Female Premier and Minister of Finance was sworn in, and during her speech she said “I’m the Man for the Job”.  While we chuckled at that colorful expression coming from a woman, who should be proud to be “the woman for the job”, we understood where the Minister of Finance was coming from.  Now some 3 months ago, the Minister of Health, beat his chest proudly in the House of Assembly and said “He is the Man, the Man for health.  No one knows more about health than me.  I am the Man”.  Now, with serious eye-rolling that I find happening more and more often whilst I am sitting in the Chamber due to the various colorful exchanges and expressions coming from the Government side, I was intrigued by the Minister of Health’s extensive reminder that he is the Health Man!  This proclamation of his manliness was in response to his Amendment to the NHIB Ordinance which he said was the first step in fixing what some deem a real drain on tax-payers dollars.  The amendment largely related to the make-up of the NHIB Board.

So, imagine my confusion last week Friday when I reviewed the Gazette and noticed that the self-proclaimed Health Man, lost the biggest expenditure in Health from his portfolio, that being responsibility for the National Health Insurance Board.  For the sake of completeness, the National Health Insurance Board is the oversight body for the Treatment Aboard Program in the Ministry of Health and Human Services.  Our contributions to NHIB not only provide funding for treatment overseas but also payment to TCI Hospitals on our behalf along with our US$10.00 co-pay we’d pay when we utilize services at one of their locations.

So, my questions today is WHO IS THE MAN?; and why is it that the NHIB spending is well over the projected budget amount of US$23,274,067.00.  When we were in the Budget Debate last year, I specially asked the Minister of Health on three occasions was the budget of US$23,000.00 enough for the work of NHIB in covering the Treatment of Aboard Program, and ancillary costs of the NHIB.   At each stage he said yes with gusto, and assured us that new structures would be in place to ensure NHIB would operate within their budget.

So, my second question is simply this, Did the Health Man fail? Is that why the Minister of Finance has come to save the day, and replace the Health Man, with the Finance Woman-Man?

What makes me ponder these questions is the response to my parliamentary question which was submitted in September (answered this week in the HOA) to the Minister of Health as to what are the costs of the Treatment Aboard Program from July 1^st 2017 to October 31^st 2017.   How is it that in just the period of July 1^st 2017 to October 31^st 2017 some 4 months the NHIB has spent US$8,659.170.00, which is US$7,131,783.00 in medical costs, US$1,000,000.00 in airfare, and US$238,000.00 in subsistence.   At this rate the total expenditure for the 2017/2018 Financial Year would be US$21,395,349.00 in just overseas medical costs. During this period a total of 418 referrals were processed resulting in the following big ticket medical costs of: US$3.3M for 80 patients to the Bahamas, US$2.2M for 183 patients to Jamaica, US$300k for 2 patients to Canada, US$391K for 19 patients to Cayman and US$153k for 1 patient to Colombia.

To say I was flabbergasted is an understatement of the amount that was spent in 4 months by the NHIB, but nonetheless we press on.   As the Minister of Health wrapped up his answer to my question, he mumbled something about primary health care being important.   So my next question is what is the plan to curb this rapid unsustainable expenditure?

To make matters even more interesting, there is a Supplementary Budget for 2017/2018 that will be debated next week, and on review of this yesterday, I note that NHIB has requested additional funds in the sum of US$12,000,000.00 increase for this financial year which ends on March 30^th 2018.  Um, that is just 8 weeks from now. US$12,000,000.00!!!! Taking the NHIB estimated budget for this Financial Year to the grand total of US$35,885.000.00!!!!   Now, that is when I noticed my heart rate began to escalate in the HOA.   Where are we going to have US$12,000,000.00 found from in the current revenue streams that we have, and further what is being cut from the Budget to make up this difference.

So in the end the forecasted outturn for this financial year 2017/2018 for NHIB expenses is US$35,885,000.00, and not US$23,000,000.00 that the Minister of Health assured the people of this Country was sufficient for their potential medical costs overseas.   While, I am here, let us also remember the Budget was debated and passed in April.   Further, the Minister of Health had ample time to prepare a practical budget, but further to that from April to October 2017, wasn’t the Minister of Health monitoring the rapid expenditure of the NHIB.   Oh wait, will they blame the former Government for this rapid expenditure to date, or let me guess Hurricanes Irma and Maria?   Remember this is the Minister of Health’s Budget, that was deemed by the Government as the People’s Budget.

My advice to the new Minister of NHIB is to be open and honest with those registered with NHIB, as this current trend is unsustainable with the 30,000 persons who are contributing to NHIB and some 39,000 users.  Where is the extra money going to come from?  We need to know and we need to know soon.  Oh, and if you’re reading this and think I got the requested figures incorrect, it is in black and white in the documents that were laid on the table yesterday, and as a Millennial, I include the screenshot for your review.

I am deeply concerned about NHIB, as there is still no Chief Financial Officer recruited, and it is bleeding funding with what seems to be no oversight, and something drastic needs to occur to severe the infected limb (pun intended).

Release:

Hon. Akierra Mary Deanne Missick

Member for Leeward & Long Bay Hills