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NHI Bahamas  »  Frequently Asked Questions

Frequently Asked Questions

1.
What is NHI Bahamas?

NHI Bahamas is a new national health insurance programme for The Bahamas introduced by Government. NHI Bahamas will make our health care system more modern, affordable and accessible. The new programme ensures that all legal Bahamian residents – no matter your income, age, island of residence or current health status – can receive health care at no out of pocket cost at point of service. Cost for health care is paid for in full or in part, by Government.

NHI Bahamas will be rolled out in phases:

In the first phase of coverage (Primary Care), Bahamians will receive a number of health services at no cost. The full list of benefits can be found here.

2.
Why does the country need National Health Insurance?

Improving the health care system will lead to a more modern and prosperous Bahamas. We must improve access and affordability of quality health care for our people. Currently, approximately 70% of Bahamians do not have health insurance, meaning they may have to pay for health services out of their own pockets. An average Bahamian household spends approximately $2,300 per year on health care, which is something many people cannot afford. Not being able to afford health care can result in illness and even death. Severe illness can be prevented often with a simple visit to the doctor, health education, and preventive activities. Modernizing our current health care system is essential to improving the health of our population.

3.
Do I have to pay for NHI Bahamas?

In the first phase of NHI Bahamas, all Primary Care services outlined in the benefit’s package here will be provided to you at no out of pocket cost at the time you access the services.

4.
Is NHI Bahamas available to everyone?

Yes, NHI Bahamas is available to all legal residents of The Bahamas.

5.
How do I register for NHI Bahamas?

The NIB will be responsible for registering all legal Bahamian residents. If you don’t have a NIB Smart Card, please contact NIB for registration locations at 225-5642. If you have an NIB Smart Card you are already registered for NHI Bahamas and prepared for enrolment. Registering will not affect those who already have private health insurance.

6.
How do I enrol in NHI Bahamas?

Once you register and have an NIB Smart Card, you are eligible to enrol in NHI Bahamas when the enrolment phase begins. To enrol, you must choose your Primary Care doctor (from the public or private sector) and your insurance company (from the private sector or NHI Bahamas’s public insurer).

7.
Under NHI Bahamas, do I have to give up my private health insurance?

No, you do not have to give up your private insurance coverage if you do not want to. Primary Care services, which are covered in the first phase, will be covered by NHI Bahamas and any additional health care services you pay for will be a top-up to that coverage.

8.
What is covered under NHI Bahamas?

The initial phase of NHI Bahamas covers Primary Care services. This includes, but is not limited to, visits to your doctor (Primary Care Provider), disease prevention, health screening, diagnostics (labs and imaging), and treatment (including medications).

The full list of Primary Care services covered under the initial phase of NHI Bahamas can be found here.

9.
What is Primary Care?

Primary Care is best described as the wide variety of health services provided to you by a family doctor or other Primary Care physician (examples also include Pediatricians, Internists, General Practitioners, and Obstetricians for prenatal services). Your Primary Care physician guides you through the health care system by referring you to specialists, maintaining relationships with nurses, labs, pharmacies and other health care stakeholders. Primary Care includes disease prevention and health promotion as well as early diagnosis and treatment of common diseases.

10.
How is the health care system being improved?

Health System Strengthening activities are ongoing and will continue to be the backbone for delivering better health system performance in the future. Change will not happen overnight and the transformation takes considerable financial and human resource efforts to achieve results. Some notable improvements that are happening are:

  • Extended clinic hours
  • Opening additional clinics
  • Maintenance and repairs to public clinics on all islands
  • Opening the Abaco and Exuma mini-hospitals
  • Opening of a child-adolescent facility on the campus of Sandilands Rehabilitation Centre to improve long-term care for children
  • Hospital improvements at Princess Margaret Hospital (PMH) and The Rand Memorial Hospital
  • Opening a community-based mental health facility
  • Additional equipment available throughout public clinics on all islands
  • All public and private providers will be held to the same certification standards
  • New contracts with long-term care/residential facilities in Nassau to accommodate more persons who should be cared for in a more appropriate setting
  • Improvements to PMH accident and emergency department to upgrade and improve patient flows
  • Building enhancements at four Nassau clinics to allow for decentralization of ambulances and extended hours
  • Fostering Private Public Partnerships
  • Enhancing the Governance and Stewardship function of the Ministry of Health
11.
Who is in charge of NHI Bahamas?

A National Health Insurance Authority (NHIA) will be established to oversee implementation of NHI Bahamas for the Government. The Insurance Commission of The Bahamas (ICB) will be involved with licensing and regulating insurance companies in coordination with NHIA. The Ministry of Health and its councils and boards will continue to provide stewardship for the Bahamian health care system as a whole, and oversee the licensing of health providers.

12.
How is NHI Bahamas funded/who pays?

Initially all funding will be from the Government’s consolidated fund financed by general revenues. This means the Government will pay for health services for all legal Bahamian residents using Government revenue collected through the existing taxation structure, and no additional tax will be imposed to pay for NHI Bahamas during the initial phases.

13.
Is there a tax for NHI Bahamas?

No additional tax will be imposed for the initial phases of NHI Bahamas. The Prime Minister has indicated that no contributions will be collected until Health System Strengthening has advanced.

14.
Will there ever be a tax for NHI Bahamas?

It is anticipated that a contribution will be needed in the future to cover the full benefits package of NHI Bahamas, but it will be rolled out when Health System Strengthening has advanced. Research shows that at least 60% of Bahamians would support a payroll deduction similar to NIB contributions to help pay for NHI Bahamas.

15.
How much will NHI Bahamas cost the Government?

It is estimated that the Primary Care phase of NHI Bahamas will cost the Government approximately $25 million for Primary Care and an additional $6 million for select catastrophic coverage from April until June. Forecasts and projections will be conducted and estimates will be updated on an ongoing basis

16.
Why is the Government starting with Primary Care coverage?

Bahamians will greatly benefit from having access at no cost to a Primary Care doctor, who will take responsibility for your care needs. Effective primary health care can address medical needs early and prevent more serious conditions from developing. According to the World Health Organization, Universal Health Care, which is based on primary health care, provides a platform for the integrated delivery of health services in addition to being one of the most powerful social equalizers among all policy options.

17.
Will NHI Bahamas cover expensive treatments for diseases such as cancer, HIV/AIDS, and diabetes?

Only treatments for diseases that can be delivered through Primary Care will be covered. There will be a fund for select catastrophic coverage available to deliver some of the more expensive treatments for certain cancers, cardiovascular conditions, etc. There is an expert group of medical professionals who are formulating evidence-based guidelines that will direct how those funds will be used to deliver care to the population that most needs it.

18.
Will NHI Bahamas cover prescription drugs?

In the Primary Care phase of NHI Bahamas, many prescription drugs are included.

19.
How is the health care system going to handle the increased demand for health services once all legal Bahamian residents have access to care?

To ensure the health care system in our country is prepared for NHI Bahamas, the Government has been investing in initiatives that aim to strengthen and modernize existing infrastructure and services, such as extending clinic hours and opening more clinics throughout the country. These improvements will help accommodate the increased number of persons seeking medical care, especially once these services are covered free of cost to the patient at point of care.

Additionally, because with NHI Bahamas you can choose a doctor in the public sector or the private sector, it is anticipated that a number of persons will opt to be seen by a private health provider, creating availability.

It is anticipated that the private health care sector will partner with public health care providers and participate in NHI Bahamas in addition to the investment the Government of The Bahamas is making to improve the public health care system.

20.
How do I select my doctor? What doctors are part of NHI Bahamas?

Once the enrolment phase begins, it is expected that you will have a choice of any doctor that is registered and certified. This list of physicians will be made available once enrolment begins. Negotiations with doctors with regard to registering with NHIA are ongoing.

21.
Do I have to change doctors?

If your current doctor has registered as a provider under NHIA, you will not have to switch. If you wish to remain with your doctor, but they are not registered, you will either need supplemental insurance or you will need to pay out of pocket for care. Alternately, you can also switch to a doctor that is certified under NHI Bahamas. These choices are up to you.

22.
How do I select my insurance provider? What insurers are a part of NHI Bahamas?

Once the enrolment phase begins, you will have a choice of any public or private insurance company that is certified to provide benefits available through NHI Bahamas. This list of insurance companies registered with NHIA will be made available once enrolment begins.

23.
Do I have to change insurance providers?

You will not have to change insurance providers if you do not want to and your provider is registered and certified with NHIA, but you will be given the option to change providers once per year as usual with insurance policies. You can also choose to be insured with the public insurer, if you wish.

24.
What is the difference between a private insurance company and the public insurer?

Private insurers are health insurance plans that are run by private entities. The public insurer is majority owned by the Government. Insurers in both the public and private sector are allowed to offer the NHI Bahamas benefits package under the same conditions to the beneficiaries.

Private insurance companies will have the option of providing supplemental insurance packages for things that may not be covered by NHI Bahamas.

25.
Will wait times increase with more people seeking health services under NHI Bahamas?

It is not anticipated that wait times will increase but in fact it is anticipated, based on international evidence, that wait times will decrease with implementation of NHI Bahamas.

26.
Will I be able to use my coverage for vision and dental care?

NHI Bahamas does not cover vision or dental care that is not provided outside of your Primary Care Provider. You would need private insurance coverage for these services, or you would have to cover the cost yourself.

27.
How will NHI Bahamas impact my maternity cost currently provided by NIB?

There will be no impact. The NIB will continue to manage maternity benefit in terms of cash subsidy. NHI Bahamas will cover prenatal care services under the first phase of Primary Care services and eventually, NHI Bahamas will cover the birth under the full vital benefits package.

28.
What happens when I use my lifetime maximum allocation for health insurance coverage?

There is no lifetime limit for NHI Bahamas.

29.
Does NHI Bahamas cover children, the elderly, people with disabilities and those with pre-existing health conditions?

Yes, all legal residents of The Bahamas will be covered under NHI Bahamas. No one will be excluded because of a pre-existing health condition, age or income.

30.
Will NHI Bahamas protect me when traveling abroad and an emergency medical treatment is required?

No. Bahamians outside of the country are not covered. It is recommended that Bahamians travelling abroad purchase travel health insurance.

31.
Will students studying abroad be able to use the NHI Bahamas coverage with hospitals abroad?

No. Bahamians outside of the country are not covered. It is recommended that a separate policy for students studying abroad be purchased.

32.
Will COB/BTVI students be required to purchase their school’s insurance coverage or would NHI Bahamas replace that?

It is suggested that COB/BTVI students continue to purchase their school-mandated insurance products. If students are also eligible beneficiaries of NHI Bahamas, then they should enrol.

33.
Don’t we already have free Primary Care right now?

No, while some specific groups, like pregnant women or children, may have free access to health care visits at public clinics, most Bahamians still have to pay for lab tests, medications like antibiotics, ultrasounds, X-rays and other services Primary Care Providers deliver. With NHI Bahamas, these services will be provided at no cost at point of service, and there will be no bill/charge to the patient. Tests and screening for disease are important in order for doctors to diagnose health problems early, which can help Bahamians from getting more sick (“catastrophic illness”) and requiring more expensive treatment (“catastrophic care”).

34.
Do I need two separate cards for NHI Bahamas and NIB?

No, the NIB Smart Card will prepare you for enrolment. You do not need an additional card.

35.
Once I have my NIB Smart Card can I go see my doctor for free?

No, Primary Care services will be offered once the enrolment phase is complete.

36.
What is the role of NHI Bahamas as part of Universal Health Coverage in The Bahamas?

The fundamental premise of NHI Bahamas is that it will provide all legal residents health insurance coverage and therefore access to a defined health services package. Under NHI, no one will be denied insurance coverage because they have a pre-existing condition, have reached old age or cannot afford to pay. Nor will anyone receive less care than they do today. NHI Bahamas will guarantee, for specified benefits, the ability to have one’s insurance coverage renewed regardless of diagnosis or amount of care required.

37.
How are members selected to be a part of the UHC Stakeholder Advisory Council and the Task Forces?

The UHC Stakeholder Advisory Council is intended to provide as broad a representation as possible of the Bahamian health care sector, civil society and the economy. The Advisory Council will enable ongoing consultation and collaboration between its members as they work together to make UHC a reality in The Bahamas.

Since it was not feasible to include the entire spectrum of relevant stakeholders on the Advisory Council, other stakeholders will participate through specific Task Teams. The NHI Secretariat is continuing to hold consultations with stakeholders and the general public across the country.

38.
What is a capitation rate?

Capitation represents a payment to a health care provider on an annual per person basis, rather than a payment for the individual services provided each visit. A capitation rate ensures medical providers are compensated on a per patient basis as opposed to a per service basis.

39.
Why is a public insurer the best option for The Bahamas?

The vast majority of funding models for UHC around the world involve either a single payer model, where there is a sole public insurer dominantly involved in the NHI programme, or a multi-payer model, reflecting the participation of both public and private insurers in the NHI model. There are few jurisdictions where the payers are solely private entities. Including a public insurer is the best option for The Bahamas because a well-managed public insurer will drive a more cost-effective, efficient, fair, and accountable UHC model.

40.
Is there geographic zoning for patient enrolment?

No, patients are free to choose any provider of their choice, however, NHI will not cover the costs of transportation for patients to visit their providers.

41.
Can a patient register for multiple Primary Care Providers? (for example a provider on the family island and another in New Providence)

It is planned that a patient will only be allowed to select one Primary Care Provider, but with better health information systems, the transfer of patient information between clinics will be more seamless. Discussions with patients and providers are ongoing as to special situations that may require the need for more than one Primary Care Provider (e.g. pregnant women).

42.
How many patients can be enrolled with a PHC physician?

The panel size of each PHC physician in a certified facility is determined based on his/her time commitment to that facility as well as other factors such as the support staff available in that facility. There will be maximum number of persons enrolled with a Full Time Equivalent (FTE) PHC physician established.

43.
Can a physician choose his/her patients?

No. Physicians are allowed to set their desired panel size (as long as it is less than the permitted number of patients). The patients will then choose their PHC physician. If a physician has a grievance with a patient, he/she may petition NHI to remove a patient from the empaneled list.