Boycott the recently mandated NHIP until concrete answers are given.

Both the contract for the new InterHealth hospitals (slated to open April 2010) and the recently mandated National Health Insurance Plan (demanding contributions as of November 2009) may be imperfect, but they are now facts of life in the TCI.  As the Governor has said, to renege on the InterHealth contract is not an option as TCIG could not afford the stipulated penalties and would still have to provide health care to a growing/aging TCI population.  So all energies should now be focused on helping to create an equitable health regime that provides "value for money" to the TCI tax payer.

Unfortunately, given the track record, any deal struck under the previous two administations will be presumed to be tainted in some way until proven otherwise.  The public has grown weary of TCIG excesses over the past few years.  And the hard part is that it has been generally left to the public to expose those excesses.  Credible institutions that should provide public oversight are not firmly established in the TCI.  But in a small country where information flows freely, it is difficult to keep extensive graft under wraps.  The COI exposed such shocking breaches of the public trust, that for the foreseeable future the TCIG will no longer be given the benefit of the doubt.  And clearly, with the InterHealth contract and the National Health Insurance Plan there are some serious doubts.

While the recent TCIG release concerning the Hospital contract has attempted to quell the gathering storm of public discontent, it has also left quite a few unanswered questions:

• Who were the TCIG employees that received "honoraria", who were they paid by and were the fees made public as soon as they were paid?  Full disclosure is an important distinction if any private entity has made payments to public officials, especially if the public officials are responsible for regulating the same private entity.  Or were these "honoraria" funneled through the TCIG? 
• With the new health scheme, TCIG is budgeting 1 million per month for Emergency Overseas Treatment. For 2007, TCIG/Southern Health Network spent three times that amount to cover less than a third of the total number of folks expected to be enrolled in the NHIP.  So either TCIG's 2010 estimates are way off the mark, or Southern Health and their proxies perpetrated massive fraud against the people of the Turks and Caicos.
• Floyd Hall, the lead man on the InterHealth and Southern Health contracts, stated in a recent issue of "The Sun" that contrary to reports, "24 million per year will address the upkeep of plant and the human resource component" for our new hospitals.  We now hear from the TCIG that it will cost at least 48 million per year to cover "physical plant and human resources".  Floyd, in the same article, asks us "not to paint with a broad brush" in assuming all TCIG dealings are corrupt.
• Freedom of information is a lynchpin to a free society.  It is disingenuous at best to explain away the publics' right to know all details of a publicly funded project (representing almost 10% of TCI GDP) by stating that "the (InterHealth) document cannot be published in its entirety, just as no similar document has ever been published in the UK."
• If nothing else, the recent collapse of local TCI government should usher in a new era of accountability.  Demands should be made by the taxpayer that the TCIG should be run as efficiently as possible.  Therefore, justification must be sought for the building and staffing of a redundant facility in Grand Turk.

Following are the moving parts to the new, recently mandated TCIG Health Regime:

The InterHealth/TCIG contract is a unique Public-Private Partnership (PPP).  It must be noted that "there are only a handful of Health related companies that have the expertise and capital to invest in a developing country like the TCI, and who would be committed to providing health care for the broader population through a government partnership".  InterHealth is a reputable company that is taking most of the risk in the financing, building and operation of two new hospitals in the TCI.  In assessing that risk, I guarantee they never banked on the implosion of the government they had struck the deal with.  But if all goes as planned, the TCI will soon be able to boast of two new, state-of-the-art, Canadian accredited hospitals.

The InterHealth/TCIG contract to build and manage the two new hospitals has now been released to a few select bodies, and early reactions are that it is not unlike the original PPC and Cable & Wireless contracts.  Clearly, savvy corporate lawyers have run circles around our local representatives and their proxies.  In his "Sun" article, Floyd Hall listed a "reputable" group that TCIG put together to "insure that the TCI got a first rate medical system".  Notably missing were folks who had some background in Public-Private health intiatives.  InterHealth has agreed to release to the public a redacted version of the contract based on non-disclosure of proprietorial information.  But apparently the contract stipulates that InterHealth is to receive "costs plus profit" for the first two years of operations.  This is not a novel or proprietorial business model.  Costs for clinical services are to ultimately be based on a "capitated formula" which is a payment of a uniform fee for each person enrolled in the program.  "The combined payments for building, equipping, maintaining, managing and providing clinical services are projected to be approx. $1200 per capita in the intial years of the contract.  If capital costs are not included, this figure comes down to appox. $650 per capita.  TCIG estimates that it will pay a premium of 5-10% over actual costs using this Public-Private health care model". 

The National Health Insurance Board (NHIB) is the TCIG statutory body that is charged with monitoring and administrating the National Health Insurance Plan (NHIP).  Contributions have now been mandated by the TCIG, but folks who prefer their private plans cannot opt out of the NHIP scheme.  November payments are soon due, and become delinquent on December 15th.  The current penalty for late payment is $5000 plus $100 for each day late.  Of course, it seems you must also keep your private insurance because InterHealth's new hospitals are not scheduled to open for another 6 months.

NHIB's budget for provision of clinical services is a moving target, but TCIG recently quoted "24 million per annum" to cover InterHealth's clinical fees for the two hospitals.  Almost half of this is to come from TCIG, the balance from TCI employees and their employers.  So over 6 million per annum from the employees' pockets and 6 million from their employers.

By TCIG's own estimates, there are 1,100 self employed folks in the TCI.  This group is being asked to pay almost 30% of all NHIP payroll contributions.  A family with two self employed individuals, as in my case, will be asked to contribute $500 per month.  I currently pay $250 for extensive coverage for the whole family from a very reputable firm with a proven track record.  So if this reputable, "for profit" firm can offer me superior family coverage for $250 per month, what actuarial tables were the NHIB using in asking $500 for my family (for service that has yet be established or fully spelled out)?  And if InterHealth is budgeting approx. $650 per capita for clinical services in year one, why I'm I being forced to pay $6000 for a young family of three.

It must be noted that TCI residents are already taxed over 35% on gross earnings.  These levies are primarily consumption taxes, but you do the math.  Import duties, fuel, communications, power, airport, licenses, permits, banks, real estate etc.  How much of your gross salary ends up in the TCIG coffers every year?  And what services do you receive for paying your taxes?  In the US, Canada, or UK, if the government mandates an additional 2.5% to 5% of payroll tax to cover a government program, they typically allow you to deduct a % from your income tax obligations to offset the penalty.

In closing, a few questions to the principals of this new National Health Regime:

To Mr. Brian Hogan and Mr. John Smith, CEO and Chairman of NHIB respectively. How can you justify demanding that the self employed in the TCI carry a disproportionate percentage of the NHIP tax burden?  Please explain why my premiums should go up 100% for an unproven, yet to be finalized product.  Also, will I be covered for premium monies paid into the plan commencing in November?

To Mr. George Commander, InterHealth Canada's local Project Director.  Why the reluctance to reveal the terms and conditions of a project that the public is being asked to pay for?  And please justify the multi-million dollar expenditure for redundant services in Grand Turk.  Wouldn't it be more cost effective to shuttle Grand Turk patients 20 minutes by air to the Provo facility?  Where did the $650 annual per capita estimate for TCI clinical services come from when the UK budgets $2,760 per capita and Canada averages over $3,500 per capita/annum?

And to Royal Robinson, as Floyd Hall's special advisor on the hospital contract and later the Minister of Health in the Williams administration.  Why, after declaring on WIV that the 10K "honorarium" from PMI Gas was a monthly payment, are you now reversing field by describing it as a one time payment?  What other "honoraria" have you received while serving as the public representative overseeing the build phase?  I have heard criticism of the public for not responding to the Insurance Plan sooner, but the NHIP was just recently passed at the end of the short-lived Williams/Robinson administration.  In fact, Royal Robinson was the chief advocate in banging it through, despite opposition.

I do believe that decent health care is a fundamental human right and I have no problem with payng my share.  I think ultimately we will all be proud of the new facilities and that they will definitely provide a boost to a sputtering TCI economy.  But to ask a group who represents barely 6% of all contributors (based on 2007 TCIG stats) to shoulder 30% of the mandated burden is unfair.  And all of this for a scheme that demands reserves on the backs of the people and has demonstrated an inability to compete with the private insurance sector.

I propose an open forum town hall meeting with the above mentioned gentlemen on the dias.  Failing a well-advertised clearing of the air, I would suggest that the general public vote with their pocket books and boycott the NHIP until the difficult questions have been answered.