1. Objectives of the Proposed Health Insurance Scheme.
It is recognized that a national health insurance scheme in Anguilla:
a) Can mobilize available financial resources in a more rational way;
b) Through the pooling of risks and costs, improve the redistribution of income between poor and wealthy segments of the population;
c) Utilization levels and the patterns of medical care can be influenced favourably, thus improving the effectiveness of medical care;
d) Productivity of health delivery systems can be increased, thus improving the efficiency of medical care;
e) Since both quantity and quality of medical care could be improved the acceptability of the scheme by the public (or at least most of the public), the Government and most of the providers can gradually increase.
These are the basic rationale and objectives supporting the establishment of a health insurance scheme in Anguilla.
2. Other Advantages of a Health Insurance Scheme
In addition to the factors mentioned above, the following elements are deemed important:
1) It stimulates and promotes the building up of hospitals, clinics, dispensaries and related facilities, which are not only valuable as treatment centers but also offer health professionals and auxiliaries new and increasing opportunities for employment which is both socially useful and remunerative.
2) It thus supports increases in the number and skills of the available health manpower; indeed, emigration of doctors, which is of special concern in some developing countries, may well be curbed.
3) It improves the health of the labour force so protected, thus increasing and, more generally, contributes to raising living standards. As each skilled worker represents a social investment (in his training, experience, etc.) so the maintenance of his health serves the good of the entire society.
4) It has general support irrespective of political doctrine, and creates health awareness.
3. Definitions
ILO Convention No. 102 (1952) concerning Minimum Standards of Social Security states that Medical Care benefits in kind include at least:
a) In the case of a morbid condition:
i) general practitioner care, including domiciliary visiting;
ii) specialist care at hospitals for in-patients and out-patients, and such specialist care as may be available outside hospitals;
iii) the essential pharmaceutical supplies as prescribed by medical or other qualified practitioners; and,
iv) hospitalization where necessary; and,
b) In case of pregnancy and confinement and their consequences:
i) pre-natal, confinement and post-natal care either by Medical practitioners or by qualified midwives; and,
ii) hospitalization where necessary.
National Health Insurance is subject to different interpretation and there is no internationally definition. Anguilla can opt amongst several models, it operates in the United Kingdom, under which all residents qualify for medical care whether or not they have contributed by way of taxes or contributions. It implies universal coverage of the population. On the other hand, the essence of all insurance is the contributory principle.
Anguilla aims at universal coverage through National Health Insurance, comprising; i) “Social health insurance”, defined as “a system of compulsory insurance whereby medical care is provided as of right in return for contributions, the insurance carrier being either the social security institution, some other agency or both in combination”, on the basis of legal provisions and regulations governing the scope, coverage, benefits, financing and other administrative operation of the scheme, and ii) coverage of the rest of the population based on government transfers of supplementary funds.
Finally, medical care can be purchased from the provider in one of two ways, as follows:
a) The prepayment system, with patients receiving medical care in exchange for a premium, and the social security institution compensating the provider of services according to a pre-arranged modality. In some cases, however, a cost-sharing element is introduced, under which the patient is subject to a direct charge at the point of delivery.
b) The reimbursement system, with patient paying for their own medical care and claiming reimbursement, in whole or in part, from the social security institution. In this report we are concerned with the prepayment system inherent to a National Health Insurance Scheme.
4. Plan Financing and Medical Expenses
The plan should be basically financed by: i) bipartite contributions by employers and employees, ii) Government’s transfers presently allocated to the Health Authority, and iii) Co-payments on user fees. It is estimated that health care expenditure in Anguilla should be around 6% to 7% of GDP, of which out-of-pocket expenses constitute a rather large proportion. The sector re-allocation of expenses through NHI would allow a more efficient use of available resources, thus yielding a higher quality of medical care at no additional cost.
5. Incidence on Government Finances
According to the Fiscal Position Report (2009):
• $26.57 million were transferred to the Health Authorities in 2009
• Salaries of Public Officers were $6.4 million per month, yielding GoA $3.8 million contributions as employer.
• Expenditure on medical private insurance amounted to $3.318 M.
