Last week’s parliamentary debate on the National Health Insurance (see Thursday paper) brought up some interesting points. The bill’s proposed name “Sustainable Affordable Access to Healthcare Act” (SAAHA) suggests a flexible approach that includes a “one-time opt-out” option with annual solidarity premium.
Much of the debate focussed on two main issues: Improving coverage while keeping the cost down. Unfortunately, though not mutually exclusive, achieving both at the same time could prove quite a challenge.
Aruba found that out when its General Sickness Insurance AZV suffered considerable early losses that government ended up compensating. It was not until rates of medical practitioners and budgets for care institutions were renegotiated or limited that this situation stabilised.
Curaçao’s Basic Sickness Insurance BVZ had initially been criticised mainly for coverage issues, while the Social Insurance Bank SVB as provider was also forced to tackle related tariffs and budgets. In fact, one can say that getting a handle on rising healthcare expenses has been a global uphill battle, but this is especially true for small islands needing to ship or fly in practically everything.
Take dental care, currently hardly covered in collective policies of the three Dutch Caribbean countries. Nobody will argue the importance of such, but the question remains at what price.
Amounts most dentists charge nowadays for different treatments appear almost prohibitive, reason why related insurance has always been viewed as rather expensive. Making it more affordable in exchange for effectively creating a broader client base is one example of what ensuring feasibility might entail.
That no premium hike has been envisioned for private sector employees sounded reassuring, because any hike with the tourism economy’s recovery from the COVID-19 crisis still vulnerable would be ill-advised. It is likely to hurt already-struggling businesses as well as particularly low- and middle-income workers plus their families, also considering average local wages compared to the high cost of living.
Truth be told, devising a system that satisfies all requirements under the present circumstances seems like a balancing act at best and Utopia at worst.