The cost of healthcare – doctor’s visits, prescription drugs, diagnostic tests, specialised health devices, and hospitalisation – has the potential to bring to nought even the most carefully made and executed financial programme.
Private insurance offers some relief, but the Government also offers some relief through several programmes and agencies it has put in place. One such agency is the National Health Fund (NHF).
Funded by 20 per cent of the special consumption tax charges on tobacco products, five per cent of special consumption tax collected, and one per cent of employer and employee National Insurance Scheme or NIS contributions, the NHF is an agency of the Ministry of Health & Wellness charged to make healthcare more affordable to the Jamaican population.
To support the national healthcare system, improve its effectiveness and make healthcare more affordable to the population, the fund offers two categories of benefits: institutional and individual.
Up to September 2020, the NHF facilitated access to individual benefits through three health cards – the NHF card, the Jamaica Drug for the Elderly or JADEP card, and the Government of Jamaica card – for residents of Jamaica seeking healthcare in the public sector to have access to all health services on the ‘vital essential and necessary list’. Today, the NHF card is what is used to access all these benefits.
People seeking assistance from the NHF for individual benefits must be certified by a doctor in the private or public sector as having at least one of the specified medical conditions on the NHF list and must register with the NHF. Application forms may be collected from a medical doctor, hospital, pharmacy, health clinic, or NHF office, and members must be registered for each condition.
The NHF is not an insurance facility, so people who register as members to derive its benefits are not required to pay premiums, which sets it off very clearly from insurance companies. Nonetheless, they are required to have their membership cards to access the specified benefits from participating providers across the island.
The NHF card gives its bearer access to healthcare in cases in which they are diagnosed with any of the chronic illnesses from the list specified by it. It has the right to make changes to the list from time to time. It includes asthma, arthritis, breast cancer, diabetes, glaucoma, hypertension, and prostate cancer, and the prescription drugs to treat each is also named on the NHF’s list.
The NHF subsidises the cost of the prescription drugs to the member. It makes a fixed payment to the approved participating pharmacy towards the cost, and the beneficiary is required to pay the difference.
In addition to the select list of prescription drugs that the NHF assists its beneficiaries to purchase, there are items such as respiratory devices, diabetic supplies, and diagnostic tests that it facilitates through participating pharmacies, laboratories, and doctor’s offices.
JADEP came into being for individuals 60 years of age or older who were certified as suffering from any from a list of conditions including arthritis, hypertension, cardiac conditions, asthma, glaucoma, diabetes, and psychotic conditions. They were required to pay $40 per item up to a maximum of $240 for six or more items from the specified drug list. Today, that benefit is still available though their NHF membership card.
The savings to the beneficiaries are significant as some of these items normally sell for thousands of dollars. My eyes nearly popped out of my head a few months ago when I realised that the regular price of a particular item on the list was well over $4,000.
The NHF singles out children, beneficiaries under 19, for special treatment. It offers them a double subsidy if they are living with at least one chronic illness that it covers, that is, double the discount on medication and medical supplies, but they must have their own taxpayer registration number or TRN to apply for their NHF card. This makes them more affordable and improves access to them so that our children can have better clinical outcomes.
The NHF card can be combined with a private health insurer’s card – which many people do not have – to cover the cost of prescribed drugs. The NHF card is used first, then the private health insurer’s card is applied against the balance, and the beneficiary pays anything else that is due.
Medical expenses are capable of eroding anybody’s disposal income. Retired people can be hit hard. Any facility or arrangement that can cushion the blows they can and do inflict can go a far way in stabilising the financial situation of individuals.
Chronic illnesses, being long term in nature, can heap devastating consequences on even people who have private health insurance coverage, some of whom also benefit from the NI Gold insurance plan available to NIS pensioners.
The NHF benefits are not as small as they may appear. They add up and may go on for years. The savings they make possible can help to improve financial well-being.
Oran A. Hall, author of Understanding Investments and principal author of The Handbook of Personal Financial Planning, offers personal financial planning advice and counsel. Email: firstname.lastname@example.org