By Elvin Bailey
When I said I would step out of my comfort zone and comment on the formation of a National Health Insurance, I was admonished. I was told that a NHI is not a step out of Social Security’s comfort zone, but rather an integral part of our being. Social Security ought to lead in this issue and let the others follow. I was directed to research the issue some more and provide more information to stimulate further in-depth discussion. I have tried to do so, but I also invite other stakeholders who perhaps know more than we do, to enjoin the public discussion about this very important topic.
What bundle of illnesses should an NHI cover, given the disease burden provided through Health Statistics? Should the top five be chosen? Should these chosen maladies be linked to our genes or to our jeans? Would choosing such a bundle of illnesses be discriminatory to persons who take care of themselves, by keeping the ‘jeans’ diseases at bay? In other words, does history (genetics) and lifestyle matter? Should it? It is arguable that choosing a bundle of illnesses may exclude many persons and, farfetched as it sounds, may not discourage lifestyle diseases.
Would it be fairer to assign a certain level of free or prepaid coverage to each individual without prejudice to their disease burden? That way, if my lot in life is a cardiac problem, then I get what I want. If your lot is something else, then you get what you want. Then, I will argue, what happens to my excess if I do not max it out each year? The answer to that question is the same answer to the social security question – we are all our brothers’ keepers, and nobody pays the full cost of anybody, rather everybody pays the cost of anybody who needs assistance. It is the principles of solidarity, equity and universality.
How a NHI is best funded? I indicated people’s tolerance to an additional 3% wage
deductions in an earlier article. I noted that an elementary NHI would require at least a 5% wage deduction. Already we can see a shortfall. Some say that the EC$5 million – EC$6 million of wage replacement under sick leave could be placed in an NHI. A lady in St. Peters objected. She was sharp. She said she needs her income to pay her bills and maintain her family, because her sickness doesn’t mean her utility bills are forgiven, and her family needs must still be met, and she will need money to pay for her medication, hospitalization, operation and recuperation! Clearly, therefore, there has to be some synergy between sickness benefit and NHI. Remember the suggestion that a sick person is one lying in bed, rather than mere indisposition?
It is my understanding that some countries apply a specific tax to fund NHI. Alcohol and Tobacco sales attract additional taxes, the so called sin tax, because they wreak havoc on a nation’s health status. Vehicle [Road] tax (especially for fast cars) attract an additional tax because of the potential to cause trauma. In other words, identify the causative factors and tax those factors. Great idea, and do-able, just like the Solid Waste tax, but how do we deal with salt, trans-fats, fried foods, fast foods, red meat, all of which can be linked to one malady or another? One health expert suggests that these items could be allowed controlled entry or they could be banned. But how do you tax an abusive spouse?
Another funding option is for government to simply pay the non-wage portion of its annual allocation towards the NHI each year.
Should an NHI pay any attention to the state and quality of health facilities? Or should they remain the exclusive domain of the Government. I would say that the NHI must target local facilities or else it will merely become a fund for medical evacuation. Recall that Social Security has already donated over US$2,600,000 to the health sector (US$100,000 each year since Independence).
Research indicates that there is a link between health care needs and aging. According to a study by Vladeck (2006) of the USA, 13% of their population consumes 40% of their health expenditure. This is because the burden of illnesses increases with age. Our population is aging and living longer and so this phenomenon is expected to be repeated here. Unfortunately, our sickness benefit coverage ends at 62, except for Employment Injury coverage, and it is my understanding that regular insurances have a cut-off point beyond which they offer no coverage. This leaves the elderly particularly vulnerable.
Some countries, like Israel, periodically review the package of diseases that are covered and publish its findings. Its appeals tribunals deal with any issues that arise concerning exclusions. Some other countries provide a minimum package and persons can opt to purchase supplementary coverage with a co-payment. Yet other countries implement price control mechanisms for doctor’s fees, hospital care and medication.
The point is that whatever system we develop must be meaningful to us. And we can only find that true meaning through dialogue, constant review and adjustment. So let us begin the ‘talk that gets results” - Now.
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