The British Virgin Islands Healthcare System: National Health Insurance, Public Hospital and Emergencies

The Ministry of Health and Social Development develops health and social protection policy. It carries out public health functions (surveillance, disease control), prepares the territory for natural and technological disasters and runs social protection programmes for vulnerable residents. Among the statutory bodies attached to it are the BVI Health Services Authority (BVIHSA), which runs public care, the National Health Insurance (NHI), and the councils responsible for registering professionals: the BVI Medical & Dental Council, the Nurses & Midwives Council and the BVI Allied Health Professionals Council.

The BVI Social Security Board and the BVI Social Security Fund come under the same ministry: they collect employer and employee contributions and pay retirement, disability, sickness, maternity and survivor pensions. The government's budget address presents the ministry's public health priorities: food hygiene, indoor air quality, water safety and screening for cervical, breast and colon cancer.

The NHI is a contributory health insurance scheme open to all legal residents of the territory and their dependants. Its frequently asked questions specify that cover begins at birth and ends at death, as long as contributions are up to date. Anyone residing in the territory must register within the month following their arrival; the registration categories include employees, self-employed workers, dependent spouses, children, retirees without a job, adults without a job and people without resources. Employers ensure the registration of their employees. The Road Town office (Joshua Smith Building, Wickhams Cay 1) then issues a health insurance card and receives employers through its online portal.

The rates: 3.75% of insurable earnings for the employee and 3.75% for the employer, i.e. 7.5% in total; 7.5% for a self-employed worker; 3.75% for a dependent non-working spouse (paid by the contributor); 7.5% for a voluntary contributor on earnings set by the board. The government covers the contributions of dependent children, non-working seniors aged 65 and over, people recognised as without resources and people under State guardianship. The cap on insurable earnings is raised periodically. The conditions of access for a foreign retiree to contributions covered by the State are not detailed on the pages consulted.

Exclusions and exceptions: tourists and short-stay visitors are not eligible. According to the FAQ, residents who live abroad for at least six months of a calendar year may be exempted from contributions; to resume their rights, they notify their return three months in advance and pay three months of contributions. The office also states that failure to register within the deadline delays the start of cover until contributions are paid in full, with a waiting period of three months from the application. The catalogue of benefits (Benefit Package) and the list of non-prescription medicines are PDF documents from the office whose content could not be read: the details of the cover should be requested from the office (1 (284) 852-7860).

According to the office, private health insurance may be used alongside the NHI, in its place or for the services it does not cover. The NHI FAQ, whose date is not indicated and some of whose older amounts no longer correspond to current caps, presents the patient share (co-payment) depending on the provider: 0% at BVIHSA community clinics, 5% at the public hospital (which it calls Peebles Hospital), 10% with a local network provider, 20% with a local out-of-network provider or abroad in network, and 40% abroad out of network. These rates should be confirmed with the office before any major procedure.

For care abroad, the FAQ indicates that prior approval from specialists designated by the NHI is required, except in an emergency; if the patient advances the costs, reimbursement up to NHI rates is possible on presentation of the original receipts, if other insurance does not already cover the service. Medical evacuation was not found in the cover read: an assistance contract remains to be considered, as in the page on repatriation assistance.

The BVIHSA is a statutory body that runs public care: operation of facilities, public health programmes, staff training and infrastructure planning. It traces its origins to the Cottage Hospital founded in 1922 in Road Town by Major H. W. Peebles. It operates the Dr. D. Orlando Smith Hospital, a 120-bed hospital in Road Town that succeeded Peebles Hospital, as well as clinics in Tortola, Virgin Gorda, Jost Van Dyke and Anegada. In Virgin Gorda, the Iris O'Neal Health Center is a polyclinic offering urgent care 24 hours a day, diagnostic tests, specialist consultations and primary care. The establishment is accredited by Det Norske Veritas, and its laboratory holds ISO 15189 accreditation through TTLABS.

The medical services published cover behavioural health, medical emergencies, haemodialysis, vaccination, imaging, nutrition, obstetrics and gynaecology, paediatrics, pharmacy and a seniors' clinic; primary care includes audiology, community health, community mental health and dental care. The BVIHSA website offers online appointment booking, a directory of doctors and a patient portal; the switchboard is (284) 852-7500. The Road Town Clinic's hours have been temporarily changed “until further notice”. The sources consulted publish no rates for uninsured patients.

The BVIHSA states that emergency services are open 24 hours a day at the Dr. D. Orlando Smith Hospital and the Iris O'Neal Health Center, with on-call cover in the other clinics. It asks the public to dial 911 in a medical emergency. The Royal Virgin Islands Police Force gives 311 as the access number for callers in the territory.

Infrastructure is being strengthened: the government has signed contracts for the renovation of the lobby of the Major Peebles wing clinics and for roof repairs and a lightning protection system at the hospital and its annex. Evacuations abroad come under assistance contracts: French health insurance, as CLEISS (the French centre for European and international social security liaison) recalls, does not cover medical repatriation.

The BVIHSA operates an outpatient pharmacy at the Road Town hospital, open Monday to Friday from 8:30 a.m. to 4 p.m.; the page mentions a temporary closure of this service without giving its current status. The NHI, for its part, publishes the list of non-prescription medicines it recognises. Prescription rules, medicine prices and equivalences with French products are not detailed on the pages consulted: the traveller takes enough of their treatments, with the prescription and the international nonproprietary name, and the government advises people with a chronic condition to arrange support from their carers and those around them before the hurricane season.

The France Diplomatie (the French foreign ministry) travel advice list includes no page for this territory at the date of consultation, and the Saint Lucia page covers only that country for health advice: medical advice before departure, from a doctor or an international vaccination centre, remains the recommended route for bringing vaccines up to date. The Ministry of Health and the environmental health division remind residents every year of the risks of dengue, chikungunya and Zika, spread by mosquitoes. During their awareness weeks, they recommend checking the surroundings every week, covering, crushing or emptying containers that hold water, removing waste that collects rain, fitting mosquito nets on windows and doors, wearing covering clothing and using a repellent.

The major seasonal risk is climatic: the hurricane season runs from 1 June to 30 November, with a statistical peak around 10 September according to the Department of Disaster Management. It recommends building up stocks of food, water and medicines, reviewing your emergency plan and insurance contracts, and identifying the nearest shelter. No vaccination coverage figure or vaccination recommendation specific to the territory was read on the official sources consulted. To compare cover, the guide to expat health insurance gives benchmarks, and the page healthcare reimbursement in the British Virgin Islands details who reimburses depending on status.