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'Hard decisions' have to be made on NHI - Hon Carvin Malone

- said NHI has become unsustainable
Acting Premier and Minister for Health and Social Development Honourable Carvin Malone (AL) has said some hard decisions have to be made to make National Health Insurance (NHI) in the Virgin Islands more effective. Photo: VINO/NHI
Persons crowd the Joshua J. Smith Building to register for National Health Insurance (NHI) on December 30, 2015. Photo: VINO/File
Persons crowd the Joshua J. Smith Building to register for National Health Insurance (NHI) on December 30, 2015. Photo: VINO/File
It was in 2018 that Director of the Virgin Islands' (VI), Social Security Board (DSSB), Ms Antoinette Skelton told the House of Assembly’s, Standing Finance Committee to examine the draft allocations for 2018 that NHI was spending more than it was earning. Photo: SSB/File
It was in 2018 that Director of the Virgin Islands' (VI), Social Security Board (DSSB), Ms Antoinette Skelton told the House of Assembly’s, Standing Finance Committee to examine the draft allocations for 2018 that NHI was spending more than it was earning. Photo: SSB/File
VALLEY, Virgin Gorda, VI- The National Health Insurance (NHI), controversially implemented by the previous National Democratic Party (NDP) administration in 2016, is on the brink of a serious overhaul, as the subject Minister has hinted a “war” on the policy.

Acting Premier and Minister for Health and Social Development Honourable Carvin Malone (AL) said some hard decisions have to be made to make the scheme in the Virgin Islands more effective.

‘Major issues’ with NHI- Hon Malone

Given a few minutes to give remarks at the Town Hall Meeting call by Minister for Natural Resources, Labour and Immigration, Honourable Vincent O. Wheatley (R9) at the Catholic Community Centre in Virgin Gorda on January 23, 2020, Hon Malone remarked that NHI has become unsustainable and "some hard decisions have to be made.”

"We have some major issues,” Hon Malone added, noting that stronger attention will be given to address the issues with NHI when the war on derelicts [vehicles & boats] is won.

He also said he has not been able to identify any jurisdiction that is void of NHI and NHS issues.

"It’s well intended but we have to find out what that intent was. We have to find out where we would like to take this in a sustainable manner, how best we can do this so that when you need the services, of the National Health Insurance, that you can gain from this."

According to the Health Minister, many suggestions are already on record and he has started the data collection processes and has been able to finger some of the issues.

36,000 registered with NHI

Hon Malone stated that NHI has some 36, 000 registered and government continues the policy of having free health care services for persons ages 1 day to 18 years and free services for seniors 65 years and older.

Similarly health care services are enjoyed free of cost by Fire and Rescue officers, police officers, prisoners, prison officers and indigent persons.

“It’s being paid for by persons between the ages of 18 years and 64 years 11 months and 29 days. Until you reach your 65th birthday we want your money, we want to be able to get this done," said Hon Malone.

A major challenge

One of the sore challenges; however, according to the Minister, is that the local public health facilities cannot bill those persons in the non-paying bracket.

"That's fine, the government contributes about $42M to take care of the hospital administration and health care for all these persons. But most persons have their private doctor. They say they don’t want to go to Peebles or they don’t want to go to Iris O'Neal (Health Centre) they want to go to a private doctor."

"So although government is paying for all these services we have to pay it twice, because when they go to a private institution then they have to get the 10% co pay, and we have 90 cents on every dollar that NHI has to pay again, so government in that case is paying twice for those services for those persons who have free health care."

This, the Health Minister said, is unsustainable.

NHI spends more than it earns

It was in 2018 that Director of the Virgin Islands' (VI) Social Security Board (SSB), Ms Antoinette Skelton told the House of Assembly’s Standing Finance Committee to examine the draft allocations for 2018 that NHI was spending more than it was earning.

NHI in 2017 earned $79,882,819 but its total expenditure was $80,476,662. This represented a net loss (deficit) of $646,843 that year.

Public input 

Another challenge, Hon Malone also highlighted, is the ability of private institutions charging for health care services higher than the public health services can.

Residents heard that communities would be given the opportunity to make their input in efforts to help the sitting government fix the flaws with NHI and health care in the Territory.

14 Responses to “'Hard decisions' have to be made on NHI - Hon Carvin Malone”

  • PIGHEADED (27/01/2020, 10:54) Like (83) Dislike (0) Reply
  • Vision (27/01/2020, 11:09) Like (74) Dislike (0) Reply
    The healthcare providers outrageous fees that they cant get from the insurance companies is by far the biggest problem,
  • lol (27/01/2020, 11:09) Like (11) Dislike (0) Reply
    the dance cant pay for the lights
  • Oh well. (27/01/2020, 11:10) Like (25) Dislike (0) Reply
    Well, you guys wanted to help everyone, which is a great thing, so NHI needs to take their lost.

    We, the people, are at lost every month we pay NHI and not using health facilities, but its mandatory. And I don't mind because I am helping persons who initially did not have insurance. So why is NHI complaining? Take your few hundred thousands lost, it was your idea.
  • Trump (27/01/2020, 11:11) Like (6) Dislike (5) Reply
    Repeal it !!!
  • Windy (27/01/2020, 11:37) Like (49) Dislike (0) Reply
    A set price for doctor’s procedures have to be established. Until then the NHI system will never succeed.
  • tretretrete (27/01/2020, 12:16) Like (30) Dislike (3) Reply
    NDP cronies grow fat on this
  • me again (27/01/2020, 15:05) Like (26) Dislike (1) Reply
    Don't forget ALL them who live in USVI and come over for them "free" medicals?
    They (NDP) meant well for those who didn't have insurance BUT it is still them who "rigged" the system to "rape"it

    Ting to talk
  • Diaspora (27/01/2020, 19:22) Like (11) Dislike (0) Reply
    Basically, insurance, ie, auto, health, property......etc is a shared risk that customers pool their resources to pay for losses. Insurance is also based on large numbers (law of large numbers); the larger the pool means the cost can spread over a large base with each person paying less. The cost of medical services is high and is rising exponentially. The rising cost, reduce revenues, coupled with increasing demand, is a presenting a challenge for NHI. Nonetheless, to ensure that each resident has access to basic health care, NHI should be mended, not repealed. To mend the NHI programme some structural changes are needed.

    The population is approximated between 32,000-34000 yet there are 36000 people enrolled in NHI. Something is rotten in the state of Denmark. The MHSS needs to scrub this list to ensure that everyone on it meets the criteria to be on it. People not residing in the territory and not contributing to the programme should not be in the programme. Of course, if someone is visiting the territory and a has a genuine medical emergency they should not turned away. Similarly, residents in the territory but are not in the NHI programme should not be turned away if they have a genuine medical emergency.

    Police officers, fire fighters, and prison officers should pay a portion of their medical cost. Each pay period, premiums should be deducted from their pay checks. The portion paid by government will be part of their compensation package. The ratio of what is paid by government and what is paid by these employees will have to be worked out and approved by the HOA. Similarly, government contract workers recruited from overseas should pay a portion of their medical cost with the remaining portion paid by government; government portion will be part of compensation package. Prisoners and certified mental patients are wards of the territory and their medical cost will be covered from the general fund. Moreover, the elderly (65=>, 65 or older) and minor children (18=<), the disable ( disable needs to be defined) and the indigent should be covered from the general fund. Employees should pay a premium to cover they and their families (spouses, children under 18) that should be matched by employers. Employers should be allowed to claim this expense as a cost of doing business on their income taxes.

    The Dr. D. Orlando Smith Hospital should be the first stop, the clearing house, for customers enrolled in the NHI programme. If the needed services are available at the hospital and the customer goes to their personal doctor for non emergency care without being referred by the hospital, the customer should bore the cost, not the NHI. If the customer is referred by the hospital (BVIHSA), then NHI should pay for the services. However, the BVIHSA will have to step up to plate to meet the demand, providing timely and high quality care. Moreover, the BVIHSA should develop a reasonable fee schedule for medical services and should negotiate the fees with doctors that want to participate in the NHI.

    For the longer term, the BVIHSA should research, develop and implement a sinking fund that residents to pay into to cover medical cost when they go into retirement. During employees working years, employees, employers and government will contribute to the sinking fund. It should be structured similarly to the Medicare programme in the US.

    Disclaimer: I’m not a trained professional in either medical services or insurance so my comment is just a wild opinion, a WAG if you will and should not be taken as sound advice.
    • Political Observer (PO) (28/01/2020, 08:32) Like (4) Dislike (0) Reply
      @Diaspora, in your disclaimer, you noted that you were neither a trained professional in medical services nor in insurance. Nonetheless, you have presented a working paper on healthcare that can be used as a framework/blueprint to improve, strengthen.......etc the NHI. Some of the proposals are going to cause some people some distress, ie, police officers, firefighters, prison officers........etc. However, everyone needs to contribute his/her fair share, sacrifice....etc to make the NHI better and extend more services to more people. The NHI is not a perfect programme; no programme is. Moreover, every programme that is rolled out is often tweaked to improve it. Further, as any programme is executed, some flaws surfaces, unintended consequences emerges........etc. These revelations should not be ignored but grab and addressed urgently to improve the programme(s).

      Moreover, there are complaints from consumers that the cost of medical services have risen exorbitantly since the rollout of the NHI. Per unverified reports, some medical providers cost have doubled for the same level of services. If true, are medical providers exploiting the situation? Did government drop the ball in not negotiating a fee schedule for medical services? Has the cost of providing medical services increased significantly since the rollout of the NHI or is something else going on? Reward medical providers whose cost are fair and reasonable and in line with market. Should medical providers fall back and charge fair and reasonable services? The Hippocratic oath states simply physicians should cause patients no harm. I will offer that sky high, exorbitant, and not fair and reasonable prices can harm patients. For example, some patients may avoid seeking needed medical service due to high (dear) prices, endangering their health and putting the national healthcare system and posture under more stress and strain down the road. Hon Malone, commission an ad hoc committee to review and make recommendations for improving the NHI programme or scrapping it altogether. Lastly, @Diaspora, the suggestion of establishing a sinking fund is out the box thinking.
    • Diaspora (28/01/2020, 08:48) Like (3) Dislike (0) Reply
      Addition: In my long comment, I inadvertently left out an important item that all of us should embrace in our health plan(s)———-preventative care. Preventative care can detect and address health issues early, improve our health and quality of life, lower cost and improve the overall health posture of the territory/nation. To my fellow Virgin Islanders and residents, don’t wait until you are in severe pain and in medical distress to race to the doctor. Make it a habit of seeing a doctor for a check up when you are feeling well just as you take your car for a periodic check up. Too many of us wait too late to see a doctor.
  • Lord O. Great news. (28/01/2020, 05:04) Like (0) Dislike (0) Reply
    No one from the know it all government wanted to hear us. We kept telling them from the NHI introduction the medical fees increase 100% . We were talking from personal experience. Before I will pay 80 dollars a visit with Nagico. With NHI introduction I pay 178=dollars. We just need to fix NHI and make it work better for's a good thing.. For some treatments and surgeries.. . So we still need that overseas option.. Trinidad is also very expressive.. We need to look at the University Hospital in Jamaica. Very good.. Santo Domingo has some very nice facilities... Also look at our regions Leeward and windward islands for those who will prefer have their surgery/treatments done in their own country include them also.
  • Lawyer (28/01/2020, 15:37) Like (6) Dislike (0) Reply
    The only people gaining from NHI are the private doctors/medical centers. They over charge for their services and they give you unnecessary procedures to increase their sales. It is a pity the NHI don't have an investigative division to catch some of them in their greed. Could you imagine how much money these people are making?
    The solution is to use the money and develop the service being offered by the hospital. The hospital should be the only place accepting NHI, all the private doctors should only use private insurance and money. This will surely bring health care cost down.
    How can you justify charging someone $180. just for a consultation, with additional charges for tests, prescriptions and any other procedure. A dentist charged me $200 for looking into my mouth (10 minutes) and I still had to pay for a filling $115.
    The government can do a gradual phasing out of private health care cost from the NHI. Develop community clinics with staffed doctors, improve health care on the sister islands, bring in a medical school that can utilize the D.Orlando Smith Hospital. The vacant top floor at the hospital should be used for consultation by appointment. All the doctors should have private consultation time as well as duties at the hospital. With a good computerize management system, networked with all the clinics, we could have a vibrant and effective healthcare system that can sustain itself.
    I know the current Minister of Health is a fair man who do not have any vested interest in the health care bonanza. So now is the time to stop this greed!!
  • Tired (31/01/2020, 23:29) Like (0) Dislike (0) Reply
    The reason it is too high is because everybody is family. You wash my back, I wash yours and we laughing straight to the bank. People who do not contribute to the system should not have privilegdes like the ones that do. If you want to see your private doctor and you get free health care in this country then I think you should be made to pay a higher % copay. People with free healthcare should only be allowed to see a private doctor if their condition is something the clinic and hospital can not deal with. People who pay into the system have to get preapproval to see a private doctor, why should the ones with free health care not be expected to follow the same routine. They don't pay into the system so they should not demand anything. Some of them want to run to the private doctor for the simplest things so they should pay.

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