HEALTH FINANCING POLICY FORMULATION IN THE EASTERN CARIBBEAN

Stakeholders formulating policies on national health insurance (NHI) i n the Eastern Caribbean have circled the abstract concept called NHI l ike the proverbial blind men explaining the elephant. Definitions of N HI have shifted depending on their perspectives and philosophical lean ings, their understanding of the issues, and their degree of influence on the process. Based on NHI feasibility studies, market research, an d stakeholder analysis conducted in five countries, this article analy ses the policy formulation stage of NHI development in these tiny coun tries. Given the level of economic development and the existing admini strative capacity of the governments, this 'phase one' NHI could be a pragmatic first step in introducing a health insurance component into the social security systems of the countries, and gradually reforming other aspects of the health sector. The article is structured around k ey questions which help to define the positions and relationships of k ey stakeholders, and then evaluate NHI plans in terms of economic viab ility, equity, administrative feasibility and efficiency, cost contain ment incentives, and political palatability. These are the elements th at-in combination with economic and political context-will determine t he success or failure of NHI in the Eastern Caribbean. (C) 1998 John W iley & Sons, Ltd.