~ Broader form of taxation needed to finance NHI ~
PHILIPSBURG–St. Maarten will come one step closer to reforming its healthcare system with insurance coverage for all, when Minister of Public Health, Social Development and Labour VSA Emil Lee tables the draft National Health Insurance (NHI) to Parliament.
Lee told reporters at the Council of Ministers press briefing on Wednesday that the draft NHI should be in Parliament for debate by the end of this year. As it relates to financing, the Minister believes that a broader form of taxation is needed to finance the cost.
Healthcare is currently financed through premiums from workers’ salaries in addition to a form of contribution from Government. “Ultimately, I think that taxing people’s salary for healthcare isn’t sustainable. I think that we need to look at some form of a broader taxation. For example, Aruba has a health tax in the form of turnover tax. This would mean that all the tourists that visit the island contribute financially to our healthcare system as well,” Lee noted.
Consultations have been taking place with the various stakeholders over the past year and while the discussions have been difficult and heated at times, the Minister believes that it is “the right step for the country.”
The Daily Herald understands that a number of stakeholders are concerned about different aspects of the draft NHI. Several stakeholders indicated that they had been concerned in a joint advertisement that appeared in this newspaper earlier this year.
Lee said there were many people in St. Maarten who do not have access to affordable health insurance for various reasons. Instead of denying treatment to the uninsured, these expenses are often absorbed by Government who ultimately pay for those services which eventually comes back to the people in forms of taxes.
The Minister said to strengthen the healthcare system, the Ministry is working towards universal healthcare coverage and the Ministry is fairly far in the process. “The conversations [with stakeholders – Ed.] are difficult, heated conversations. It is a time-consuming process, with a lot of energy spent on trying to build consensus,” the Minister said. “It is important that the public realises that the way things have been continuing right now cannot continue. We need to structure our healthcare sector from all aspects. We need to improve the quality of care, the access to care, and how we finance it.”
Lee said worldwide, national health insurance is something that everyone recognises as being important. The World Health Organisation’s (WHO’s) technical definition for universal health coverage is the ability of all people in communities to be able to use promotive, preventative, curative, rehabilitative and palliative health services that they need of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship.
He said equity and access to healthcare services means that everyone who needs services should be able to get access to them; not only those that can pay. The quality of healthcare services should be good enough to improve the health of those receiving the services, and people should be protected against financial risk ensuring that the cost of the services does not put people at risk of financial harm.
WHO, in its constitution, identifies healthcare as a fundamental human right, a principle to which the Ministry of VSA agrees. “These are things that all the members of our community, I don’t think, have problems to agree on,” Lee said.
Globally the discussion about healthcare (universal health coverage) is a very difficult discussion, he said. It is a topic that very often divides countries. Lee alluded to discussions in the United States regarding Obamacare and Trumpcare as examples of the difficulties experienced in universal healthcare discussions.
“The question about having access to quality healthcare is undeniable. The question becomes, define quality, define access, and the difficult question of how do you fund it? Fact is that healthcare costs globally are steadily increasing. As technologies and new medication become available, those costs only continue to increase,” he said. “Structuring our healthcare system and our health insurance system is a critical way of managing the quality, the efficiency, the effectiveness, and the cost to the country.”