fp Turks and Caicos

Members of the Chamber of Commerce got an in-depth review of private versus government-sponsored health plans by Martin Regan, director of Accordia Insurance.

Private v. government health programs

Regan said he does not advocate that private insurance is a better system than government sponsored plans.

“Having grown up in the National Health system in the U.K. and having had extensive experience in the U.S. private system, it would be wrong to say one is better than the other. However, there is misconception on both sides.”

According to Regan, private insurance is generally more efficient and sometimes more cost effective than government plans because it reduces waiting and referral time. But it does underwrite the clients, so those with pre-existing conditions or without the means to pay the premiums are excluded.

“In the United States, there seems to be the notion that there is no coverage for individuals without private insurance or Medicare / Medicaid, but certainly as far as emergencies are concerned, every hospital has to treat anyone in life threatening condition.”

Regan said he believes the National Health Insurance Program concept is good, but he is concerned about the funding; i.e., adequacy of contributions.
“For any insurance to work, the premiums have to exceed the claims simply just to balance the books. The reason being that in additions to the claims, there are outgoing costs of administration, processing advertising, salaries, etc., which have to be met from incoming revenue — the contributions.”

A range of options

Choice of plans, deductibles and providers — choice cannot be emphasized too much.

“You pay for the plan which suits you and your family’s requirements and budget. These could range from a critical care only, to full comprehensive worldwide plan covering everything from preventative care to unlimited medical care in any facility anywhere in the world.”

Everyone’s requirements differ. Regan says the plan you had five years ago might not be the one you should be on right now. A case in point is maternity.

“There is no point in having a plan which has great maternity benefits if you do not intent to have children. Sounds basic, but a proportion of your premium is subsidizing someone else’s plan.”

Treatment abroad seemed to be one of the hottest issues for the members.

“We are fortunate in the TCI we are 90 minutes away from some of the best medical facilities in the world. So with a car accident when the individual is stabilized after consultation with the doctor here, the patient is taken by air ambulance to Miami to intensive care at a pre-arranged hospital, undergoes the treatment, hopefully is the on the road to recovery / recuperation.

“With illness, the biopsy or scans are available or will be available on island, the results of which would determine if the person needs to see a specialist. From there surgery / treatment would be administered.”

Proposed benefits by NHIP

Regan says as a primary provider, the draft schedule of benefits he has seen appears to be comprehensive in the coverage, to the extent it offers more benefits than some private plans offer currently.

“In some ways it is difficult to gauge the scope since I am not sure if the benefits have been finalized, so to some extent we are looking at the proposed benefits which might increase or decrease as the plan progresses.”

He says low co-pays, either zero or $10, are important to the plan because it dissuades people from using the services when there is little or nothing wrong with them. It also covers dental and ophthalmology, which are usually limited or not covered on private plans.

As for treatment abroad, “I think it has always been NHIP’s intention to utilize Caribbean facilities in preference to those in Miami on a cost basis. I would have thought initially the U.S. would not be an option due — as the governor delicately put it last week on another issue — ‘We are constrained by financial resources.’ But as NHIP plan evolves, this may or may not change.”

Regan says he believes there is room for private medical plans to run in conjunction with the government plan as happens in U.K. and in Canada.