PHILIPSBURG (DCOMM):--- The Minister of Public Health, Social Development and Labor (Ministry VSA), Hon. Veronica Jansen Webster said on Thursday in response to a press statement by the Soualiga Employers Association (SEA) about the Sustainable Affordable Act (SAAHA) (formerly known as National Health Insurance (NHI)) will have the ability to achieve long-term sustainability and improved healthcare for the residents of the country.
90% of persons are already insured with Social Health Insurances SZV. At this moment a vast majority of costs for ‘expensive’ care are already covered by the Government/SZV.
SAAHA will be adding premium payers, not consumers of expensive care, to the pool of SAAHA insured persons. Hence, the changes will make sure that a larger part of these costs will be covered by premiums of people who will now join: Co-insured persons will pay a premium; Uninsured persons; Privately insured persons with higher incomes; Government will pay a premium for civil servants instead of reimbursement of the costs; Persons who Opted-out will pay a solidarity premium as well.
Regarding the lack of risk pooling, the persons insured with SZV are in different funds. Therefore, there is insufficient risk pooling: the young and relatively healthy workers are in different funds than vulnerable and elderly people. The healthy and wealthy do not compensate for the vulnerable.
If we continue without SAAHA, elderly will be hit hardest. If the funds are not united to one as proposed in SAAHA, the premiums of the individual funds have to be increased. The elderly will be hit the hardest with an increase of their premium to 25%. They have the highest costs and lowest premiums at this moment.
The deficits of their fund are highest, which necessitates higher premium increases than for the other funds. Total income instead of only salary will be taken as base for the calculation of premiums.
Regarding an opt-out, this could exacerbate the funding gap rather than alleviate it. We fully agree with this. To prevent the funding gap caused by opt-outs, a solidarity premium is introduced for this group.
The solidarity premium includes a premium paid for long-term care (AVBZ) which is not covered by private insurers as well as an amount to compensate for the fact that private insurers do not invest in the health infrastructure. It would be unfair if people who opt-out do not contribute with a premium for the use of a health infrastructure which was paid for by the people insured via SAAHA.
Regarding Government’s non-compliance in contributions, the SAAHA legislation includes provisions to ensure Government complies with their mandatory contributions, and the supervision of the CBCS includes authority to obligate Government to comply with their financial responsibilities to the fund.
It has been stated by the SEA that the primary objective of the SAAHA is to address the financial deficit of the health funds administered by SZV rather than focusing on delivering better healthcare for citizens. This is absolutely not true!
The focus of SAAHA is affordable and sustainable access to quality care for all citizens of Sint Maarten. However, better healthcare delivery cannot be achieved with the current unsustainable funding of our national health system.
In other words, SAAHA is essential to enable optimization of our health infrastructure, and the quality of the care delivered. It goes without saying that a well-functioning and financed health system is a prior condition to keep our population healthy and well.
SAAHA provides improved and more sustainable funding. Moreover, it provides provisions and instruments to manage health and wellness of the population better. One of the major objectives is to allow access to health insurance for people who do not have access now.
For example, sole proprietors do not qualify for access to the public health funds and a private insurance is too expensive for most of them. With SAAHA they will have access, and last but not least, the fragmentation of our public health funds has also led to differences in entitlements. With SAAHA all citizens have access to the same improved package.
