Health Wise
April 4, 2017
National Health Insurance – when is it coming?

Asking everyday Vincentians to navigate health insurance is like asking passengers to fly the plane. Without proper education on health insurance and access to information on health care and health insurance, it is nearly impossible to avoid turbulence along the way.

Most Vincentians do not have health insurance. A study done by the National Insurance Services (NIS) as part of a feasibility study on National Health Insurance some years ago, showed that the health insurance coverage among Vincentians was significantly low. National Health Insurance and the services offered by the NIS must not be confused. The NIS offers social security, although some aspects of this cover a limited suite of health-related conditions.

Vincentians who have health insurance do so privately or may be covered under company plans. The Government of St Vincent and the Grenadines does not provide health insurance as a benefit to public servants. I have written numerous articles and publications on this important topic.

Health care in St Vincent and the Grenadines is generally provided free of cost to the public. However, as Vincentians, we know the limitations to this. We have seen people soliciting help to cover health care expenses oversees, because not all services, especially those at the secondary and tertiary levels, are available on island. As a result, high health care bills must be covered by health insurance or by out-of-pocket expenses. Company coverages generally have restrictions and sometimes offer no help when severe medical conditions occur. This can leave one frustrated and cause them to be in a condition that is equally the same as someone without coverage. High out-of-pocket expenses could result in financial catastrophe. It can drive families into poverty.

It is time for us to start considering how do we handle the issue of health care financing. Like we saw this week, health care financing is not an easy task. The United States, which spends way more money than us per capita on health care, is still battling with financing health care. This was evident in the debate on Obama Care and Trump Care this past week. However, there will come a time when we have to confront this difficult, but necessary topic.

A study conducted by myself and published in BMC Health Services Research 2015, “Willingness to participate and Pay for a proposed national health insurance in St Vincent and the Grenadines: a cross-sectional contingent valuation approach”, showed that almost 70 per cent of Vincentians were willing to participate and pay for a National Health Insurance plan. This shows that Vincentians do understand the need for health security. Without health insurance, out-of-pocket spending on health can be catastrophic.

Out-of-pocket healthcare spending is a worrying issue. There are many Vincentians who do not have enough capacity to pay to cover their health expenses, and such expenses could become catastrophic, leading to poverty and even death.

It is necessary to establish intervention mechanisms in order to improve equity in access to health services and payment for health care, protect vulnerable population against financial risk, and reduce the incidence of catastrophic health care spending.

Dr Rosmond Adams, MD is a medical doctor and a public health specialist with training in bioethics and ethical issues in medicine, the life sciences and research. He is the head of Health Information, Communicable Disease and Emergency Response at the Caribbean Public Health Agency (CARPHA).

He is also a member of the World Health Organization (WHO) Global Coordination Mechanism (GCM) on the Prevention and Control of Non-Communicable Diseases (NCDs).

(The views expressed here are not written on behalf of CARPHA nor the WHO)

Dr Rosmond Adams is a medical doctor and a public health specialist. He may be emailed