The Tribune

By RICARDO WELLS

Tribune Staff Reporter

rwells@tribunemedia.net

BETTY North, 67, yesterday became the first patient treated under the government’s National Health Insurance scheme, this as officials tout that “in excess of 100 providers” are now associated with the programme.

Officials heralded this as the start of NHI’s primary care phase.

Presented as “another critical milestone” in public health services by NHI project manager Dr Delon Brennen, Mrs North’s visit to general practitioner Dr Brian Tynes, marked the first time a patient enrolled for NHI Bahamas, selected their doctor of choice and received care without cost at the point of service.

Asked about the developments surrounding funding, scheme upgrades, patient and practitioner sign-ups, Dr Brennen maintained that the NHI rollout is going “extremely well” despite the public discourse and apprehension surrounding the scheme.

Speaking on the sidelines of Thursday’s event, Dr Brennen said the enrolment of nearly 9,000 persons and roughly 100 medical practitioners stood as proof that NHI is “progressing very well” while moving Bahamians closer to “modern, affordable and accessible care”.

Dr Brennen told The Tribune: “We have been working on this for the greater part of three decades. Initially, we had signed up in excess of 60 of our private providers and now we are into, in excess of 100 providers total who would have been able to get into the programme.”

Dr Brennen added that there are another 40 to 50 providers in the scheme’s pipelines as it shifts its focus to family island providers and other private providers throughout New Providence.

In response to questions over how these doctors would be compensated for their service, Dr Brennen sidestepped concern over direct funding, noting that the government had changed the model of care such that physicians aren’t paid per visit.

He explained that officials have opted to incentivise and prepay physicians based on the health outlook of each individual patient.

He indicated that this style of compensation limits the chances of “acute episodic care”, encouraging both patient and practitioner to keep an ongoing dialogue over conditions identified during visits.

“This way we are actually incentivising and prepaying physicians to be able to see their patients that the healthier they keep them the more a provider will see in benefit so they don’t have to spend all the money in overhead and acute visits that come along with the patient,” said Dr Brennen.

“They’re able to have a repayment mechanism and are allowed to make sure they co-ordinate all the care services for the patient and not just waiting until the patient comes in and deliver only the care that needs to be delivered at that time.”

Dr Brennen indicated that plans are designed to approximate how much care each patient will require over the course of a year, and then total charges for every patient assigned to a practitioner.

“We work out what the payment amount is going to be and deliver that entire amount to the provider in equal allotments over the course of the year. It’s a lot better for providers because they know they will have predictable source of income and it doesn’t fluctuate on how many patients they get,” he noted.

Meanwhile, NHI officials are aiming to conclude contract negotiations with a NHI’s public insurer in the coming days, according to Dr Brennen.

The selected party will act as the NHI Authority.

Asked whether that lack of such authority could hinder current developments, Dr Brennen responded: “The issue isn’t that we need the public insurer in place to deliver payment. What is important is that we have a payment mechanism in order to deliver that.”

He continued: “Right now the NHI Authority is going to be the mechanism by which the providers actually get paid. Once the regulated health administrators (RHA) are in place, the expectation is that the NHI Authority would basically take the per capita adjusted amount for each patient per year, deliver that to the RHAs along with an administration fee and the RHAs would then make payments to providers so payments no longer come directly from NHI or the NHI Authority but through the RHAs who would become the co-ordinators for the individual beneficiaries and making payments to providers based on when and how patients are being seen.”

Dr Brennen said it was his final expectation that the NHI programme will grow in the public and private sector to include 150 to 200 providers.

He added that once that is realised, NHI could guarantee that it would never “run out of physician capacity.”

“At that point it will truly be about the patient’s choice on which provider they would want to go to.”

The NHI enrolment process is ongoing and Bahamians are encouraged to enrol online at www.nhibahamas.gov.bs, or in person at several enrolment locations in New Providence.

Enrolment centres include Cotton Tree Plaza at Bernard Road; Enoch Beckford Memorial Auditorium on Carmichael Road and New Providence Community Centre on Blake Road.

Residents in the Family Islands can enrol online or in person at their local NIB office.