Backgrounder: “National Health Insurance: A Shared Responsibility” Policy Paper

Nassau, The Bahamas – October 23, 2018 – Today, the National Health Insurance Authority (NHIA) released a policy paper, entitled National Health Insurance: A Shared Responsibility, which outlines the proposed policy framework for advancing the National Health Insurance (NHI) program. Under the new proposal, NHI Bahamas promises to be affordable, realistic, and sustainable, with a goal to act as a catalyst for change in the way Bahamians experience health care.


The purpose of the paper is to present key stakeholders with a vision for the Bahamian health system and policy expansion of NHI Bahamas, for their input and feedback. Expansion of the NHI benefits package include:

  • Expanded primary care benefits package
  • Coverage for treatment of certain chronic illnesses (“high cost care program”)


The new direction proposes that primary care services be expanded to include cancer screening programs and diagnostic imaging. The new benefits will include comprehensive cancer screenings for the most common cancers in The Bahamas, many of which are easily treated with appropriate care. The new diagnostic imaging services will include various x-rays and ultrasounds, such as prenatal ultrasounds. The impact of this expanded primary care program will be to make preventative care accessible and affordable, and with a greater impact on our total well being.


In addition, a high cost care program will be implemented to include comprehensive coverage for select conditions or treatments, all of which have a high prevalence in The Bahamas, including breast cancer, prostate cancer, colon cancer, rectal cancer, cervical cancer, ischemic heart disease (heart attack), pacemaker needs and end-stage kidney disease.


Several other components to the proposed framework are also outlined in the policy paper.

  • A national wellness program
  • A Standard Health Benefit (SHB)
  • Employer/employee shared insurance coverage (“Employer Mandate”)
  • Risk equalization amongst private health insurers
  • Focused role for the NHIA as a public payer
  • Quality improvement in the delivery of health services


Concurrently with NHI, a national wellness program will be rolled out, which will include initiatives aimed at improving the health of the population over time. The program will focus on prevention, health education, health promotion, and community outreach programs and will be funded through taxation of certain unhealthy products, such as sugary drinks.


A Standard Health Benefit (SHB) will be established to ensure all health insurance plans in The Bahamas offer the same benefits package outlined by NHI to all Bahamians – this includes the expanded primary care package and the high cost care program. All licensed health insurance providers will be required to provide the SHB at the same cost, including private plans with comprehensive coverage.


The establishment of an Employer Mandate will require businesses and employees to share the cost of the SHB premium – with some exemptions outlined in the policy paper. It is estimated that employees will pay 2% of their salary to a maximum of $42 per month, with the employer paying the remainder of the premium. The Employer Mandate will be phased in, starting in January 2020 for businesses with over 100 employees, then eventually will be expanded to include all employers over the coming years. Employers will be responsible for providing the SHB to full-time and part-time employees working over 15 hours per week.


Risk equalization will be used to keep premiums affordable and maintain the insurance industry’s focus on innovation and delivering effective models of care. The intention of risk equalization to promote fairness by adjusting the risk profile of an individual insurer to equalize with the national risk pool of all insured Bahamians.


Under the new model, the NHIA will act as the public payer focused on helping those who do not fall under the Employer Mandate, including children, retirees, non-working spouses and unemployed persons. Moving away from a single-payer model to a shared responsibility with a single pricing approach will make NHI Bahamas more affordable and sustainable and aligns with the Government of The Bahamas’ commitment to fiscal responsibility.


Lastly, an important aspect of the proposed new framework seeks to position NHI Bahamas as a catalyst for change in the way Bahamians experience health care – by implementing a values-based payment system that incentivizes providers to improve the quality of care. By tying a portion of provider compensation to service quality, providers are incentivized to follow best practice guidelines, be proactive and preventative in their approach to care, and collaborate with each other for the good of the patient.


The policy paper is posted on the NHI Bahamas website for stakeholders and the public to review. Stakeholders and members of the public have 45 days to submit their responses through the online consultation survey which can be accessed here:

The NHIA will also be scheduling individual meetings with stakeholder groups and will be hosting town hall meetings in New Providence, Grand Bahama and the Family Islands during the consultation period.


Based on the feedback collected during the consultation period, the NHIA will then present recommendations to the Government of The Bahamas on the way forward for NHI Bahamas.



For more information on NHI Bahamas, visit


National Health Insurance: A Shared Responsibility


Contact the National Health Insurance Authority:


Phone: 242-396-8500

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