Who is the Man?

As a lawyer, I regularly read the Gazette when published on Fridays as it contains valuable
information for my legal practice. Last week I read with great interest the changes in portfolios of
Ministers specifically the Minister of Finance and Premier, and the Minister of Health, Human
Services and Agriculture, which are to commence on February 1 st 2018.

Reader, I urge that you walk with me as we take a trip down memory lane. Some 13 months ago, the
first Female Premier and Minister of Finance was sworn in, and during her speech she said “I’m the
Man for the Job”. While we chuckled at that colorful expression coming from a woman, who should
be proud to be “the woman for the job”, we understood where the Minister of Finance was coming
from. Now some 3 months ago, the Minister of Health, beat his chest proudly in the House of
Assembly and said “He is the Man, the Man for health. No one knows more about health than me. I
am the Man”. Now, with serious eye-rolling that I find happening more and more often whilst I am
sitting in the Chamber due to the various colorful exchanges and expressions coming from the
Government side, I was intrigued by the Minister of Health’s extensive reminder that he is the
Health Man! This proclamation of his manliness was in response to his Amendment to the NHIB
Ordinance which he said was the first step in fixing what some deem a real drain on tax-payers
dollars. The amendment largely related to the make-up of the NHIB Board.

So, imagine my confusion last week Friday when I reviewed the Gazette and noticed that the self-
proclaimed Health Man, lost the biggest expenditure in Health from his portfolio, that being
responsibility for the National Health Insurance Board. For the sake of completeness, the National
Health Insurance Board is the oversight body for the Treatment Aboard Program in the Ministry of
Health and Human Services. Our contributions to NHIB not only provide funding for treatment
overseas but also payment to TCI Hospitals on our behalf along with our US$10.00 co-pay we’d pay
when we utilize services at one of their locations.

So, my questions today is WHO IS THE MAN?; and why is it that the NHIB spending is well over
the projected budget amount of US$23,274,067.00. When we were in the Budget Debate last year, I
specially asked the Minister of Health on three occasions was the budget of US$23,000.00 enough
for the work of NHIB in covering the Treatment of Aboard Program, and ancillary costs of the
NHIB. At each stage he said yes with gusto, and assured us that new structures would be in place to
ensure NHIB would operate within their budget.

So, my second question is simply this, Did the Health Man fail? Is that why the Minister of
Finance has come to save the day, and replace the Health Man, with the Finance Woman-Man?
What makes me ponder these questions is the response to my parliamentary question which was
submitted in September (answered this week in the HOA) to the Minister of Health as to what are
the costs of the Treatment Aboard Program from July 1 st 2017 to October 31 st 2017. How is it that
in just the period of July 1 st 2017 to October 31 st 2017 some 4 months the NHIB has spent

US$8,659.170.00, which is US$7,131,783.00 in medical costs, US$1,000,000.00 in airfare, and
US$238,000.00 in subsistence. At this rate the total expenditure for the 2017/2018 Financial Year
would be US$21,395,349.00 in just overseas medical costs. During this period a total of 418 referrals
were processed resulting in the following big ticket medical costs of: US$3.3M for 80 patients to the
Bahamas, US$2.2M for 183 patients to Jamaica, US$300k for 2 patients to Canada, US$391K for 19
patients to Cayman and US$153k for 1 patient to Colombia.

To say I was flabbergasted is an understatement of the amount that was spent in 4 months by the
NHIB, but nonetheless we press on. As the Minister of Health wrapped up his answer to my
question, he mumbled something about primary health care being important. So my next question is
what is the plan to curb this rapid unsustainable expenditure?

To make matters even more interesting, there is a Supplementary Budget for 2017/2018 that will be
debated next week, and on review of this yesterday, I note that NHIB has requested additional funds
in the sum of US$12,000,000.00 increase for this financial year which ends on March 30 th 2018. Um,
that is just 8 weeks from now. US$12,000,000.00!!!! Taking the NHIB estimated budget for this
Financial Year to the grand total of US$35,885.000.00!!!! Now, that is when I noticed my heart rate
began to escalate in the HOA. Where are we going to have US$12,000,000.00 found from in the
current revenue streams that we have, and further what is being cut from the Budget to make up this
difference. So in the end the forecasted outturn for this financial year 2017/2018 for NHIB
expenses is US$35,885,000.00, and not US$23,000,000.00 that the Minister of Health assured the
people of this Country was sufficient for their potential medical costs overseas. While, I am here, let
us also remember the Budget was debated and passed in April. Further, the Minister of Health had
ample time to prepare a practical budget, but further to that from April to October 2017, wasn’t the
Minister of Health monitoring the rapid expenditure of the NHIB. Oh wait, will they blame the
former Government for this rapid expenditure to date, or let me guess Hurricanes Irma and Maria?
Remember this is the Minister of Health’s Budget, that was deemed by the Government as the
People’s Budget.

My advice to the new Minister of NHIB is to be open and honest with those registered with NHIB,
as this current trend is unsustainable with the 30,000 persons who are contributing to NHIB and
some 39,000 users. Where is the extra money going to come from? We need to know and we need
to know soon. Oh, and if you’re reading this and think I got the requested figures incorrect, it is in
black and white in the documents that were laid on the table yesterday, and as a Millennial, I include
the screenshot for your review.

I am deeply concerned about NHIB, as there is still no Chief Financial Officer recruited, and it is
bleeding funding with what seems to be no oversight, and something drastic needs to occur to
severe the infected limb (pun intended).

– Hon Akierra Mary Deanne Missick