By way of background, Mr. Speaker, this Government’s philosophy on health care was articulated in its 2007 Manifesto which was laid on the table of this Honourable House on 6 March 2008. It states, among other things, that Government must provide adequate health care services within easy access of all residents of the Virgin Islands. Access to health care goes beyond physical access, as important as that is. There is also a duty to ensure that factors such as age, gender, ability to pay, and socio-economic status do not form barriers to health services based on the needs of individuals.
It is for this reason, Mr. Speaker, that the Government undertook to create a health financing system to ensure sustainable and universal access to health care, by reactivating previous efforts to introduce a National Health Insurance System for the Virgin Islands.
I was assigned responsibility for the National Health Insurance System in the summer of 2009, and you would recall Mr. Speaker, earlier this year, on 12 July, I spoke briefly on the roles of private insurers in the National Health Insurance System, especially the need for their collaboration in the areas of case management, supplemental coverage, reinsurance, and overseas care, particularly given the large existing overseas provider networks that most providers currently have.
I now wish to speak briefly on the project and the work that has been completed to date as the Government seeks to bring the National Health Insurance System on stream.
A National Health Insurance System, Mr. Speaker, provides coverage for the entire population against the costs associated with illnesses. Premiums are based on ability to pay, rather than on a report of a health risk, such as a pre-existing health condition. What makes it ‘national’ is that no one is excluded from coverage.
In essence Mr. Speaker, it is health insurance coverage designed to ensure that every person, young and old, residing in the Virgin Islands, will have access to quality, affordable and efficient health care services. It also aims to increase the resources available to finance health care, thus improving the quality of health services, and it controls costs in the system.
In order to fully achieve the delivery of this system Mr. Speaker, in March 2010 the Government contracted the services of the University of the West Indies Health Economics Unit, led by Professor Karl Theodore, to complete the design and support the implementation of the System. The former Government had also Mr. Speaker, in years before, engaged the same team.
The project is spearheaded locally by a multi-sectoral technical steering committee that works in tandem with the consultants to ensure that all aspects of the NHIS address the health needs of the people of the Territory.
Mr. Speaker, Cabinet has decided that the National Health Insurance System be administered as a new division of the Social Security Board (SSB); with completely separate financial arrangements, including the complete segregation of all National Health Insurance funds from all social security funds. This management arrangement is seen as the least costly and most practical option, given the already established track record of the Social Security Board.
In March 2011 a successful Study Tour to the National Health Insurance Board in the Turks and Caicos Islands (TCI) was undertaken by a joint team comprising representatives from the Ministry of Health and Social Development, the Social Security Board (SSB) and the Health Economics Unit of the University of the West Indies. The Study Tour served to facilitate discussions with the TCI’s National Health Insurance Team, and other officials, about various aspects of their implementation experience, which provided learning opportunities for the BVI.
I am pleased to inform this Honourable House and the public, that to date, the project team has been making steady progress towards the completion of the design of the NHIS. At the end of 2010 the consultant had completed three (3) phases of the project which dealt with:
• reassessment of the National Health System;
• update and reassessment of Private Health Insurers; and
• re-examination of the Laws of the Virgin Islands
Several draft reports have been submitted and are under active review by the Ministry of Health and the Project Steering Committee. These include:
1. Financial Model for the British Virgin Islands National Health Insurance. This is an actuarial presentation of the expected revenue and expenditure flows of the NHI for a 20-year period;
2. Benefit Package outlining the health care services which are proposed to be covered in the system;
3. Draft Legislative Framework, including National Health Insurance Regulations;
4. Draft Directory of On-Island Heath Care Services;
5. Analysis of Overseas Health Care Experience;
6. Report on the NHI System Design and Costs;
7. An Assessment of the Private Health Insurance Industry;
8. Guidelines for NHI Medical Referral System and Case Management; and
9. System Functionalities and Technical Specifications for the National Health Insurance Information System, among other documents.
Upon completion of the review process, the proposed features of the System will be discussed with members of the public across this entire Territory, in order to ensure that everyone has the opportunity to contribute to the final design of the National Health Insurance System. In support of the communications process, a Communications Team was established and has conducted several planning/strategy sessions which, with assistance from HEU consultants, have led to the development of the NHI Communication Strategy. It is intended that this strategy will be fully rolled out over the course of the coming weeks and months.
Following the design phase, Mr. Speaker, implementation efforts will begin in earnest. These would involve: (i) Registration of Beneficiaries; (ii) Arrangements with public and private Health Care Providers; and (iii) Procurement and Installation of the Information Technology Platform. The procurement of an IT Platform is a crucial component of the NHIS; as it would provide the central management information system necessary to facilitate information sharing with private and public healthcare providers. It would also support an electronic Health Information System (eHIS), which is required for the efficient operation of the New Peebles Hospital. Demonstrations have taken place, and a Request for Proposals (RFP) has recently been finalised for the procurement of the Health Information System.
Mr. Speaker, as Minister of Health I am of the strong conviction that the Territory will benefit greatly from the implementation of this NHI system as it would serve to transform our system of health financing in a way that would fundamentally improve the quality of delivery of healthcare in these Virgin Islands; while ensuring the provision of healthcare coverage for all citizens and residents, regardless of their socio-economic status.
I thank you Mr. Speaker.