NHI claims hospital attempts to over-charge too

The National Health Insurance (NHI) has stopped just short of claiming that the management of the state-owned Peebles Hospital – like private healthcare providers – has been over-charging NHI contributors for services rendered.

Deputy Director at the NHI Roy Barry, who recently called for the situation to be rectified, noted that the healthcare providers have rejected a fee schedule that was proposed by the NHI.

The proposal was for the providers to charge NHI patients no more than 5 percent above a fee schedule that would have been set by NHI.

Since the healthcare providers rejected the proposal, they have been accused of widespread price gouging.

Barry recently told the Standing Finance Committee of the House of Assembly that there is need for the Ministry of Health to intervene, and put an end to what is referred to as balance billing.

Balance billing, which is also called extra billing, is when a healthcare provider bills a patient for the difference between what the patient’s health insurance chooses to reimburse and what the provider chooses to charge.

Balance billing, Barry told the parliamentary committee, is unfair to the patients.

The committee, in its report made public this month, explained: “The Deputy Director (Barry) indicated that, at the inception of the NHI programme, it was recommended that [private healthcare] providers not be allowed to charge [patients] more than 5 percent above the fee schedule set by the NHI, which can be termed as balance billing.”

“The providers disagreed and were allowed to balance bill, which is unfair to patients. So he (Barry) recommended that that the Ministry of Health and Social Development look at imposing a zero percentage balance billing so that providers must accept the fee schedule that the NHI is offering, and recognize that – with the utilization [of NHI] increasing – they would realize a profit at the end of the day,” added the Standing Finance Committee.

Turning to the state-owned Health Services Authority (HSA) that manages all local public health facilities, the parliamentary committee paraphrased Barry as saying: “The HSA was also attempting to balance bill, which needed to be rectified as they are a public facility, and they should be adhering to the programme which was implemented by the Ministry of Health and Social Development of which they are also a division.”

Attempted market control failed

Barry further told the parliamentary committee that there is no legislation to mandate that healthcare providers adhere to the proposed NHI fee schedule.

But he explained that ‘an attempt was made to control the market’.

Once that attempt at market control failed, the NHI has not received any authority to further implement anything regarding price control, added Barry.

In the meantime, then Permanent Secretary in the Ministry of Health Petrona Davies told the Standing Finance Committee that the government is attempting to have more services available in the public healthcare system to NHI contributors.

That, she said, will help reduce the cost of healthcare to the NHI contributors.

The parliamentary committee, in its report, further paraphrased Davies. “The Permanent Secretary (Davies) stated that one of the things that was being looked at for reducing the dollar value of the claims [against NHI] over time was to have more specialists procedures offered on island, so specialists would come in to do procedures on persons that would have otherwise have had to fly overseas,” the committee said in its report.