National Health Insurance – Considerations for SVG

I have written on the issue of National Health Insurance (NHI) various times before. I recall that in one article, I presented the advantages of NHI to small islands like St. Vincent and the Grenadines. In that article I discussed how NHI can be used as a tool towards Universal Health Coverage.

On another occasion, I wrote on the disadvantages of NHI in the context of Small Island Developing States (SIDS). I also recall that I presented the concept of NHI and the results of a contingent valuation study that I conducted in 2014, in which I examined Vincentians willingness to pay for a hypothetical NHI plan. The results of that study showed that almost 70 per cent of Vincentians were willing to pay for NHI.

The concept of NHI is one that is easily presented. However, to design, implement and sustain such a plan there are several issues that must be examined and addressed before a hasty move towards NHI.

1. What is the understanding of National Health Insurance?

One must examine if Vincentians understand what exactly National Health Insurance is, or what will NHI mean in the Vincentian context. There can be confusion between NHI and the currently existing National Insurance Services. Further studies must be done to examine the current understanding of NHI and the expectations of such plan.

2. Who will contribute to the plan?

NHI is a pooling system where generally the employed will pay for the unemployed, the young will pay for the elderly, and the rich will pay for the poor. It is a system of pooling and redistribution of resources. It is hoped that the young, who are generally healthy, will contribute for a longer period and will not utilize much services. Premiums can be easily collected from government workers and from the private sector. However, those who are self employed or unemployed will have difficulties contributing to the plan. Systems must be put in place for voluntary contribution for the self-employed. The unemployed, youths and seniors, must be subsidized by the government. The unemployment rate must be looked at and government must decide what proportion of unemployed it wants to cover. If the unemployment rate is too high, then government will end up paying for the system and this can be very costly.

3. What will the suite of services be?

Health care is very expensive. If NHI is established, one must examine what will be the services that will be covered. The suite of services must be responsive to the demand for health care. The system must reduce the burden on individuals and on families when paying for health care. Depending on the diseases covered, care can be lengthy and very expensive and so if the system is not well designed it can become bankrupt easily.

Careful considerations and thoughts must go into NHI. We ought to look at countries like Taiwan that have been successful in implementing NHI. In the meanwhile, there are other approaches that can be taken into consideration to improve access to care for the local population.

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 a lecturer of medical ethics.

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 Global Coordination Mechanism on the Prevention and Control of NCDs.

(The views expressed here are not written on behalf of CARPHA nor the WHO). You may contact him at adamsrosmond@gmail.com