National Health Insurance

In 2012, I conducted a study in St Vincent and the Grenadines entitled “Willingness to participate and pay for a proposed National Health Insurance in St Vincent and the Grenadines: a cross-sectional contingent valuation approach.” The representative study, published in the journal BMC Health Services Research, consisted of a sample size of just over 400 respondents and showed that Vincentians were generally willing to participate in a National Health Insurance plan, should one be established.{{more}} It also provided valuable information that can guide policy makers on setting premiums, should the country move in the direction of implementing a National Health Insurance system.

This study, the first of its kind to be conducted at the micro level in St Vincent and the Grenadines, builds on previous studies conducted here by the University of the West Indies at the macro level.

As we speak about Universal Health Coverage and as the health care landscape becomes more complex with an increasing burden from chronic non-communicable and emerging diseases, it is important for us as a nation to consider alternative ways of financing health care at both the macro and the individual levels.

Many countries that subscribed to the Millennium Development Goals (MDGs), now the Sustainable Development Goals, have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection.

Despite the many benefits that health insurance may offer, there are potential risks that must be considered also. The journey to implement NHI and achieve the benefits is challenging, long, and risky. Policy makers and technicians that support development and scale-up of health insurance must figure out how to increase the country’s financing capacity, extend health insurance coverage to the hard-to-reach populations, expand benefit packages and improve the performance of any existing schemes and the overall health sector.

Some of the potential benefits of a NHI are:

1. It can protect households from impoverishment due to high out-of-pocket spending on health care.

2. It can increase access to and use of services where payment is normally required at the time of need.

3. It can greatly influence provider and consumer behaviour to improve quality, efficiency and effectiveness.

4. It can harness private providers to address national health goals and objectives.

5. It can generate additional and more stable resources for health.

6. It can expend resources for and access to priority health services for the disadvantaged and can assist in the redistribution of resources for health to address socio-economic inequities.

National Health Insurance therefore has the potential to decrease out-of-pocket spending on health care, especially in developing countries like St Vincent and the Grenadines. It will help in cost recovery for the health sector and it can protect the poor from falling into poverty due to high out-of-pocket spending on health care.

It is important that National Health Insurance be given careful consideration, as it is now widely debated on the political platform as a way of strengthening health care services and delivery in the country. It must be cautioned that NHI is not a mag­­­­­­ical solution for a perfect health sector, but serves as a major financing mechanism that has the potential of helping to improve the delivery of health care. The potential risks of NHI are also numerous and will be addressed in our next column.

Dr Rosmond Adams is a medical doctor and a public health specialist. He may be emailed at adamsrosmond@gmail.com