COMMENTARY: What we thought we bought
By Dr. Craig Stoutt, Contributor
I have watched too many of my patients learn the hard way that what they thought they had paid for, they had not.
The grandmother who believed her care was covered, and met a bill she could not pay. The worker who contributed faithfully for eighteen years, and arrived at the clinic to discover his condition was not in the benefits package. The mother who waited because the public side could not stretch any further, and chose between the bill she could see and the one she could not.
These are not stories about NHI failing as an idea. NHI is the right idea. The idea was that healthcare in the Virgin Islands should not depend on what is in your bank account. That was right ten years ago. It is right today.
The question is not whether to have NHI. The question is whether what we thought we bought ten years ago is what we are getting now.
Most Virgin Islanders do not actually know what NHI covers. That is not a criticism of the public. It is a sign of how the conversation has been allowed to drift. People know that money comes out of their paycheck every two weeks. They know there is a benefits package. They know that when they walk into a clinic, something is supposed to be different than it used to be. But the line between what is covered and what is not – the line that decides whether a Virgin Islander walks out without a bill or walks out with one they did not expect – that line is not as visible as it should be.
I see patients every week who arrive at that line and learn for the first time that the line exists.
They were told NHI would protect them. Often it does. Sometimes it stops at a boundary the patient did not know was there. And the patient is left holding what the system used to be responsible for.
That is the gap between what we thought we bought and what we are getting.
I worked inside our public health system for years. I know what NHI was meant to do. So when I write that the gap is real, I am not writing as a stranger to the system. I am writing as someone who has watched it from the inside and the outside, and who has cared for the patients who fall through it.
None of this means NHI has failed.
It means NHI is now ten years old, and the promise we made ourselves at the beginning needs honest care. Anniversary speeches are not honest care. Press releases are not honest care. Honest care is sitting down with what is working, what is not, and what we owe each other now that we know more than we knew at the beginning.
A country that takes its health seriously asks these questions out loud. Not as accusation. As stewardship.
Every Virgin Islander who has contributed to NHI deserves a system that honours their contribution. Every Virgin Islander deserves to know, before they reach the counter, what the system will and will not do for them. And every Virgin Islander deserves a seat at the table when that promise is reviewed – a public review of the NHI benefits package, done in the open, where the people who pay in can see what they are paying for.
That is not a complaint.
That is what any honest country does with a promise it made to itself.
In the next article, I want to write about what this country could become if we get our health honest – a country known not only for its beaches and its banking, but for taking care of its own.
We can do better. We have done better. And we will.
Dr. Craig Stoutt is a Consultant Anaesthesiologist and Intensivist with more than twenty years of service in the Virgin Islands health system. On Our Health is a series on the state of our health and the country we can still build together.
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This NHI conversation should not be about defending or opposing the system. It should be about fulfilling the promise that the government made to the people of the Virgin Islands.
Every working Virgin Islander who pays into NHI has invested in the hope that quality healthcare will be there when they need it. Every family that faces illness deserves to know what is covered, not be confused, before they ever walk through a clinic door.
Now, a decade after its inception, it is entirely legitimate to ask whether the benefits package still meets the needs of our people. Finding out what works and what doesn’t, and talking openly with contributors, is not a sign of failure, but of a mature and accountable system.
We must never forget who NHI is for: the people who pay into it and the people whose health and dignity depend on it. They should be told what is happening. They are entitled to value for their contributions. They deserve a health care system that can keep up with the requirements of our community.
The discourse shouldn’t stop after a celebration of ten years. It should start by asking how the next decade can better serve all Virgin Islanders.
Good governance is about honouring promises, not just making them.
They can do better. They’ve done better before. And they should do so again.
Made doctors and so called health providers rich , the tax payer poorer , with no improvement in the quality of national health.
I believe that almost all health insurance, by design, is written to confuse and obfuscate. At its core, the system seeks to collect enough in premiums to pay out where needed, while balancing risk against premiums in order to remain solvent. In larger countries, where there may be an expectation that people will not fully access their benefits because of a lack of knowledge, I can condemn that approach while still understanding it. Here in the BVI we want all residents to access their benefits to impact quality of life, the transparency you seek is justified.
Perhaps there is room for a public-private partnership or independent advisory service where residents can have their health insurance policies explained clearly and free of cost. Even professionals struggle with the complexity of health insurance. One tool avaiable is AI which does a great job of analysing complex documents and giving stratighforward answers.
What system are non Virgin Islanders paying into that they should have a say in??? I thouvht it was NHI.
Thank you Craig, for another, thoughtful and thought-provoking piece. You truly have your fellow men at heart.
My respect to you sir / but you seems to have left out those thiefing ” employers ” and the people who allowing them to not Pay in their fair share of taxes that they are deducting from their employees / even the government is getting ripped off in the same process and it’s allowed to go along as if it’s not a big deal , because its their family and friends who are the perpetrators ( that is so (appalling ) that this kind of dirty behavior was swept under the rug / and its not we virgin islanders alone paying * NHI * saint Andrew & cousin Vinnie didn’t correct that ” SH*TTY RODEO GAME INSTEAD THEY DREAM UP A WONDERFUL SCHEME OF MANIPULATION ON ” DEM ISLAND PEOPLE ” AS WE DOES CALL THEM , USING MONEY GRAM AND WESTERN UNION TO DOUBLE TAX THEM WHILE THEY ALLOWED THEIR FAMILY AND FRIENDS TO CONTINUE TO THEIR EXPLOITATION OF INNOCENT PEOPLE WHO WORKING HONESTLY TO MAKE AN HONEST LIVING / ANDY BRAGGED HOW HE GOT (2 MILLION OFF THEM ” ISLAND PEOPLE ” AFTER BEATING HIS CHEST LIKE “KING KONG ” , BUT “KARMA” IS THE GREAT EQUALIZER , AND WILL GIVE US WHAT IS DUE , SO DON’T THINK YOU GOT AWAY WITH MURDER • YOUR TIME WILL COME TO SUFFER THE CONSEQUENCES OF WHAT YOU DO TO OTHERS/ GOING DOWN ON YOUR KNEES WON’T FOOL * GOD *
What we the taxpayers were forced to purchase but neither own or control.