fp Turks and Caicos

UPDATED NOV. 4:

Just days after the public comment period closed, the governor and his Advisory Council increased government health insurance rates from 5 percent to 6 percent of salary and set a monthly minimum payment of $50.

Insured workers also will have to pay $10 per dependent per month, including up to three children, and work permit holders will no longer be covered for overseas medical treatment if required.

Copayments will be eliminated for primary care, which will get more financial resources in the future. A primary care clinic will in Blue Hills will be opened before the end of the year.

“I believe that these decisions will improve how we conduct health care business here in Turks and Caicos Islands by improving delivery and making its future more sustainable,” Permanent Secretary of the Ministry of Health and Human Services Judith Campbell said Nov. 4 at a press conference with His Excellency the Gov. Ric Todd.

The National Health Insurance Plan rate increases will add an estimated $5 million a year to pay for health care.

Dozens of people who commented on proposals to reduce the cost of government health care were against increasing national insurance rates but they didn’t object to requiring insurance payments for dependents, Campbell told the fp.

Currently only the 18,000 people who are employed pay into the National Health Insurance Plan (NHIP), but their 11,000 dependants get full coverage.

Summarizing the comments sent by e-mail during the three-week comment period that ended Oct. 31, Campbell said that everyone who commented supported implementing contributions for dependents.

People also approved of a six-month waiting period before coverage would begin for new employees. Not having such a waiting period was an “oversight,” Campbell said.

The changes are aimed at addressing the $42 million annual health care deficit that government has to pay.

The biggest costs are the amounts paid to InterHealth Canada Limited (ICL) — $20 million for infrastructure and equipment costs and $24 million for clinical services to operate the hospitals on Providenciales and Grand Turk. NHIP currently raises only $19 million.

Government contracts with ICL will be reviewed in 2012 in hopes of lowering costs, a solution supported by some comments. The contracts with ICL have a step-by-step procedure for requesting and reaching agreement on changes, both by government and ICL, Campbell said.
The contracts will also be audited before the end of the year, giving a clearer picture of the costs involved and what might be changed, she said.

However, discussions are already underway with ICL to reduce costs on several fronts:

• Reducing interisland travel for diagnostic procedures
• Reducing overseas referrals for procedures that can be performed on island
• Reducing the number of medical consultants from out of the region and increasing the use of professionals from the regional “preferred provider network”
• Employing more regional people and Turks and Caicos Islanders across all non-core positions

In fact, NHIP has already discontinued overseas treatment out of the region when it can be performed in the region. Any treatment out of the region must be approved by a medical advisory team. The ministry has not yet calculated how much savings might be realized by this measure.

ICL is also looking into offering on-island chemotherapy and radiology services, and is in negotiations with a group out of the Bahamas that will be providing the services.

Approximately $411,000 would be saved each year by eliminating overseas treatment for work permit holders.

“Some people thought that was of course unfair, and probably unconstitutional to do something like that,” Campbell said. “However, it is not unprecedented. It has been done in other countries where you don’t get the full benefits under the medical plan as the residents or native population.”

Campbell said there should be a system in place to make sure those people could be returned to their countries and continue to receive necessary care.

Comments on imposing or increasing copayments for some services were split, with some thinking it would prevent people from seeking health care and might worsen their conditions in some situations, Campbell said. Others thought copayments, especially in the emergency department, could reduce visits for non-emergency situations, which would reduce the more expensive emergency care costs.

Government is also looking into the idea of medical tourism, where patients could come to the TCI for treatment that is cheaper or that is not approved in countries like the United States, Campbell said. Both the ministry and ICL are pursuing a number of proposals, and approval has already been granted for prostate and cosmetic treatments. Other proposals include stem cell interventions, sports medicine and pain management.

Government would receive 50 percent of net revenues from third party medical tourism.

Medical tourism also could help the under-utilized Cockburn Town Medical Centre on Grand Turk, and government is considering using part of the facility for TCI residents in long-term care and/or geriatric care.

Campbell said most people who commented on the proposals commended the governor for the approach of gathering public comments.

Click here to the the government's statement on costs of the Health Care Funding Challenge

Click here to read the government's Statement on the Health Care Funding Challenge