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National Health Insurance (NHI)

Context

JIPA Network serves as a trusted advisor to Caribbean governments implementing National Health Insurance (NHI) systems.

We support the design, administration, and operationalization of NHI programs with an emphasis on sustainability, population health, and system integration. Our experience includes developing benefit packages, building claims systems, and aligning provider reimbursement with national health priorities. Our proprietary NHI Management Information System is currently being used to support national reforms, including the SPRC (Stratified Pooled Risk Coverage) model in Grenada.

The Challenge

Designing and operating an effective NHI system requires more than a funding mechanism. Key challenges include:

Fragmented or incomplete health data systems. 
Unpredictable claims volumes and poor actuarial forecasting. 
Resistance from providers or stakeholders due to unclear reimbursement mechanisms. 
A lack of trust in how funds are collected, pooled, and used. 
High administrative costs if systems aren’t integrated. 
Political cycles that disrupt continuity and long-term planning. 
Our Approach

JIPA provides full-spectrum advisory and administrative services for NHI programs:

  • Policy & Legislative Design: We assist Ministries in drafting health financing laws, regulations, and operational frameworks.
  • Benefits Package Development: We help define tiered or stratified coverage models based on clinical need, risk pooling, and available resources.
  • Claims Management Systems: We deploy or customize electronic claims adjudication systems with real-time analytics.
  • Provider Contracting & Pricing: JIPA supports capitation models, bundled pricing, and aligned incentives for high-quality outcomes.
  • Capacity Building: We train health authorities and third-party administrators (TPAs) in managing enrollment, service authorization, and financial reconciliation. 
Recent Engagements: 
  • Grenada: Developed policy frameworks, cost models, and NHI IT systems for national implementation.
  • Barbados: Cost containment consultation for integration into national health financing reforms. 
Why JIPA?
We bridge the gap between policy and implementation. JIPA combines public health strategy, provider network contracting, and operational experience — helping governments move from concept to functioning NHI systems that deliver equitable results.