Review queries cover for poor

(CNS): The health cover given to the country’s poorest people as well as veterans and pensioners needs to be urgently addressed, the civil service review team has said. In its first report on government agencies the team, which is examining ways to cut the current public expenditure levels, said that as indigent health care represents the highest cost per insured in the CINICO client groups, the national insurance company has to change the system. The team also revealed that there was no accountability in the decisions over who is designated as indigent. The review identified more than $7 million in savings at CINICO, which alone consumes ten percent of the country’s operating budget.

CINICO has already suggested that indigents, SHIC plan holders and veterans should be placed in a “Medicare” type plan with restricted overseas care arrangements to reduce the $51m government spends on providing health care each year to more than 13,000 people. The team said they supported the recommendations made by the general manager for restricted care arrangements, particularly with respect to overseas care to UWI Mona (Tony Thwaites) private wing and two other US facilities only.

“While it sits outside the remit of this review, policies impacting the cost of health care for indigents need to be urgently addressed,” the review team said in its report. “The current arrangement whereby the DCFS determines eligibility for ‘indigent status’ and costs for careare borne by the Ministry of Health provides no accountability for decisions.”

Although the review tram said analyses reveals that CINICO operates efficiently from an expense to premium ratio as well as from a benefits paid to premium ratio, the team said the
“status quo” in terms of health care coverage for civil servants and other customers is not sustainable.

“The team understands that legal considerations may prevent changes to benefits with respect to existing civil servants but recommends that policy-level decisions be taken and implemented as soon as possible with respect to the specifics of health care coverage for future civil servants and pensioners,” the report states.

The review also notes that careful consideration will need to be given to co-insurance, co-payment, deductibles dependants’ benefits and coverage of over-the-counter medications to influence user behaviour and better manage costs. “The team recommends that choice in health care provider is considered if client groups are assessed some form of payment,” the report revealed.

During its examination of potential cuts in CINICO costs the review team said that one of the critical issues facing CINICO was the lack of a clear strategic plan. The team noted the conflict of interest with respect to private sector members of the board, as well as the degree of political influence over operational management decisions which have been raised as potential concerns, and said alternative governance models for health insurance provision for CINICO clients should be investigated. It suggested the creation of a National Health Care Council comprising representatives from the Ministry of Health, HSA, DCFS, PSPB, PoCS, Seafarers and Veterans Associations and relevant legal and financial representation, which could replace the board and bring a more strategic focus.

The review team also said CINICO could take on the role currently fulfilled by third party administrators if it was properly resourced with skilled, trained personnel and the right IT systems.