National Health Insurance (British Virgin Islands)
[1] A National Health Insurance scheme was first considered in 2006 (if one ignores the efforts as far back as 1985 as evidenced by the 1986 Budget Address by then chief minister Cyril B. Romney),[2] but it took over a decade to come to fruition.
From a relatively early stage of the scheme's life, doubts were expressed about its long term sustainability.
He expounded upon this in 2020, noting the government has to subsidise the scheme to the tune of US$42 million a year, and if it was not reformed it could "bankrupt the British Virgin Islands".
[10] The shortfall is paid principally by the Ministry of Health[11] and the balance is either written off or allowed to roll over as uncollected debts by the BVIHSA.
[11] User fees are estimated to recover just 8% of the operating costs of primary and secondary health care services.
[2] Attempts to reduce the strain on Government by increasing the cost of services have proved to be politically controversial.
However, the proposal remains controversial amongst the public, not least because - in simple terms - it amounts to the equivalent of a 7.5% increase in taxes.
[17] However, even with the expected revenue from the NHI scheme, the hospital will still be heavily underfunded, with an estimated budget shortfall of US$7 million in 2016.
[23] This is consistent with press assumptions that, because NHI will involve making deductions from payroll (which will be perceived similarly to a tax increase), implementation would likely to be postponed until after the 2015 general election (which occurred in June).
[29] Shortly after registration commenced, an online petition started urging the Government to abandon the proposed National Health Insurance scheme and reconsider the issues.
[31] Concerns have also been expressed in the media and by politicians that the additional levy on salary (for both the employer and employee) would depress wages and limit job creation.
[37] Despite the fact that the official census records a population of just over 28,000 in the Territory, nearly 40,000 enrolled in the NHI scheme, which may reflect a large number of non-residents living in the nearby U.S. Virgin Islands who hold BVI citizenship also registering.
[6] All insurers are required by British Virgin Islands law to maintain a regulatory licence to conduct insurance business, to have business plans and financial feasibility approved by the independent regulator, and to deposit capital in a secured account with respect to long term contingent liabilities.
In November 2016 the director of the scheme, Roy Barry, announced that thousands of employees were to have their benefits withdrawn because their employers had not paid over the relevant contributions.
Contributions will be based on a percentage rate applied to a maximum of twice the national insurable earnings[43] which was most recently set at US$38,610 per annum for 2014.
[34] When released the second actuarial study indicated that the expenditure could be as high as $81,000,000 (or 14% higher than projected), and that the Government's contribution would thereby increase to approximately $43,000,000.
The same report also indicated that 36,057 persons were registered with NHI at the end of 2017, despite the resident population of the British Virgin Islands being only approximately 27,000.
[48] This followed a period of sustained criticism when allegations were made about providers dramatically increasing prices, and users of the scheme being left with large charges under the co-pay.
