Open Letter to the Minister of Health Doctors Concerned About National Health Fund

Five physicians in Anguila have expressed concern about the recent press release in the implementation plans for the proposed Heath Insurance Fund.

The physicians said they had met with Ministry of Health representatives in May 10, 2007 and had written a letter expressing their concerns. They said the letter was acknowledged but no other correspondence or discussions had taken place. They are sharing their concerns with the public in the following letter which was sent to the Ministry.

Mr. MacNeil Rogers
Minister of Health
Government of Anguilla
The Valley
ANGUILLA

May 31, 2007

Dear Mr. Rogers,

On May 10, 2007 a group of five private doctors met to discuss their concerns regarding the proposed National Health Fund and submit the groups’ concerns in writing to the Government and Governor of Anguilla, prior to the scheme’s implementation.

The doctors agreed that there is a need for Universal Health Care Insurance in Anguilla. Concern was expressed that implementation of the plan in its’ current form would lead to its’ failure. There are many countries where Universal Health Care Insurance plans had failed. It is important that the causes for these failures be examined to avoid the same mistakes.

The group believes that the basic tenants of the plan should be:

a. It is affordable for all residents – permanent and temporary

b. It should provide coverage of basic health care needs
c. The subscribers should have a choice of providers
d. There should be a variety of plans to meet the needs of a diverse population like Anguilla
e. The existing quality of health care would be improved
f. There would be prompt and efficient access to health care
g. Sound referral systems should be established. Contact should be made with regional hospitals and US hospitals to ensure all have access to the required care.

There is a concern that the proper foundation has not been laid for the plan to be successfully implemented by the date intended. Following are some areas that need to be addressed:

a. There are no reliable statistics on private and public utilization of health care services locally and abroad

b. There has not been a cost analysis of the existing health care delivery system
c. The medical and administrative resources to manage such a Fund are not in place. Personnel would need to be trained and technology introduced and established for the management of financial and statistical data, to avoid costs incurred through outsourcing of work.

d. Lack of medical director to advise and assess medical issues.

e. Collections have not commenced so there will be no funds available for payments.

In conclusion, the group feels that consideration should be given to:

a. Collecting data from private health care providers and insurance agencies prior to implementing the Fund.

b. Conducting analysis of data to project utilization and attendant costs.

c. Utilizing existing insurance agencies which have the experience and the personnel to manage such a plan.

d. Purchasing a group policy from the insurance companies for contributors and use the National Health Fund for non-contributors.

e. Educating the Public about the scheme via public forums and be give them the choice of whether to accept or decline the scheme.

f. Having those receiving duty free concessions contribute to the provision of health care insurance for those unable to contribute.

g. Utilizing 1%-2.5 % of existing Social Security contributions into a Health Fund for the indigent population.

h. Concentrating on improving health care delivery at the hospital and clinics.

i. Explaining in detail how the plan will pay providers.
j. Explaining to the private doctors how signing on and payment to them will work.
k. Providing a skilled liaison who can communicate between the Government, the Public and Private providers.

l. Giving the plan a more nationalistic slant. If all locals pay into a single payer system, then persons wanting to access primary health care on St. Martin should be self-pay.

We trust that consideration be given to addressing the concerns outlined above, prior to implementing the National Health Fund.

Sincerely

Lowell A. Hughes Rona Hodge-Lake Clyde Bryan Brett Hodge Arjoon Jagan

CC: Mr. Stanley Reid, Deputy Governor of Anguilla