The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Government says “real improvements” are already occurring in the public health sector as a result of ongoing reforms, citing a 17 per cent reduction in emergency room visits in Freeport due to longer clinic opening hours.

The Christie administration’s National Health Insurance (NHI) discussion paper for Monday’s meeting with the Medical Association of the Bahamas (MAB) argued that there was “no reason” to delay National Health Insurance’s (NHI) implementation due to fears the Bahamian health system was not ready for the scheme.

The document, obtained by Tribune Business, said health system strengthening (HSS) activities were focused solely at the primary (initial) care level, because these were the only services that would be offered under NHI during the 2015-2016 Budget year.

It added that reforms at the secondary and tertiary care levels would be “undertaken” while NHI was underway, as the primary care focus would effectively buy the Government time to implement changes there.

Responding to the MAB’s concerns over the public health sector’s readiness for NHI, something the doctors had described as the scheme’s “Achilles heel”, the Government paper attempted to reassure that its recommendations for strengthening the system had been taken into consideration.

With the proposed NHI registration start now less than four weeks’ away, the Government briefing document said: “Health system strengthening recommendations were taken into account in formulating all strategies, and the actions under way by Public Hospitals Authority (PHA) and Department of Public Health (DPH) are working to change the system.”

Giving examples of the changes, the briefing paper said the Government had “decentralised ambulances to reduce emergency response times”, with one vehicle already placed at the Flamingo Gardens Clinic in Nassau.

The public health clinics were now moving to extend their opening hours, with four to achieve this before year-end. Doctors were being sent to the Family Islands, while contracts for the training of patient care assistants had been signed.

Those for the training of community health nurses and workers were being developed, while contracts for infrastructure improvements at three New Providence clinics had been signed.

A Health Information Management System has been selected, and “outsourcing” contracts for housekeeping and landscaping at the New Providence clinics tendered to “reduce costs”.

“The increase in the open hours of the clinic in Eight Mile Rock, Grand Bahama, has led to a decease of 17 per cent in emergency room visits at the Rand Memorial Hospital (RMH),” the Government’s discussion paper said. “These are real changes that are starting to see real improvements already.

“It should also be noted that an important recommendation... was ‘enrolling clients into a ‘medical home’, establishment of a single governance structure and creation of regional networks, all of which are planned under health system strengthening.

As for the MAB’s call for NHI to be phased-in, the Government paper responded: “There are a number of responses to this:

“NHI is commencing with primary health care services only. As such, the push for health system strengthening in the public sector is at the primary care level.

“There would be no reason to delay NHI’s implementation while waiting for secondary and tertiary level improvements. Those will continue to be undertaken as the initial phases of NHI are underway.”

The document added: “Additionally, there is no reason to believe that simply strengthening the health system will improve outcomes. Structural changes are required to introduce a logic of contracting for results and population-based health approach, which are at the core of NHI’s value proposition.”

Many, though, remain unconvinced about the Government’s NHI proposal, with Opposition leader, Dr Hubert Minnis, yesterday slamming the “chaotic manner” of its implementation.

Calling on the Government to delay NHI’s launch so that it can develop a more “sustainable” plan in concert with the healthcare industry, Dr Minnis, a former health minister himself, backed the concept of universal coverage for all Bahamians.

“Because of the lack of proper assessments and evaluations, not surprisingly the Government is unable to say what the roll-out of NHI will cost the people of the Bahamas,” Dr Minnis said.

“With only one month before implementation, Prime Minister Christie has yet to specify what comes with the NHI scheme. Christie is a man in dreamland with no specific detail, and is refusing to be guided by any sensible or sound advice to delay the launch of NHI - asleep at the wheel again.”