Junior Minister of Trade Marlon Penn has called for legislation to be enacted urgently to help stop the forces that he said continue to work against the National Health Insurance (NHI) plan when they overcharge NHI beneficiaries who seek healthcare.
“It is an issue that many countries have had to deal with. Even in the US right now there was a Fair Pricing Act that was launched in California to try to help deal with these types of issues. I think we need to look at similar legislation to ensure that the systems that we create to help our people and build our health services industry are not abused [and] are not taken advantage of,” Penn said.
He raised the issue in the House of Assembly on April 20 after noting that he has been receiving complaints from patients who have fallen victim to the practice.
“The concerns that persons have raised to me as it relates to the escalation in fees and the escalation of cost of healthcare, creates what we call the whole issue of balance billing.”
Effectively, balance billing is when healthcare providers bill patients the difference between what they choose to charge and what the health insurance (NHI) actually reimburses.
For example, a medical procedure costs $10 but NHI only covers $8. The healthcare provider then charges the patient the remaining $2.
“It (healthcare providers over-charging) creates a significant hardship to persons on the lower scale when they are paying for healthcare in the Territory at this point,” Penn said.
Describing the practice as a force that is ‘fighting against the NHI’, Penn urged Minister of Health and Social Development Ronnie Skelton to investigate the issue and address it swiftly.
“We’re going on the second year of NHI, and we cannot allow for this very important institution we’re building…to be destroyed… So we really have to do something quickly as it relates legislative [measures] to curb this type of behaviour.”
Responding to the concern raised by the junior minister, Skelton described those over-charging patients as ‘dishonest’ and as ‘mercenaries’.
He noted that he is working to develop the services being offered at the government-owned Peebles Hospital in order to reduce reliance on the private sector.
Better services will attract more patients to the hospital, which Skelton said already has competitive and fair prices for its healthcare services.
“The NHI has to work… I know people who came to me saying that this facility they wanna charge $2,800 for a procedure [but] the same procedure is being done at Peebles Hospital for $600… [However] there are people who want to go to the private doctors,” Skelton further said.
“My responsibility as the minister for health is to provide a better service at Peebles Hospital, and I think we’re on the road to doing these things. And, if we do that, then people will have choices [as to where they can get good and reasonably-priced healthcare].”
Skelton however told the House of Assembly that, if the over-charging problem persists, “then we need to do legislation to stop people from being mercenaries, so to speak”.
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