The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A well-known physician yesterday said the latest spending revelations and changes to the National Health Insurance (NHI) plan amounted to an attempt to “bribe” the Bahamian people and doctors into accepting it.

Dr Duane Sands, the former FNM senator, told Tribune Business “there’s something wrong” if the Christie administration has to offer numerous financial incentives to induce Bahamian doctors into signing up for NHI’s preferred care model.

Describing the Government’s approach as “bait and switch”, he suggested that the $31 million being allocated to cover the first three months of NHI primary care costs was intended to create the impression that the scheme was ‘free’.

This, Dr Sands said, was intended to “hook” the Bahamian public and gain their buy-in, softening them up for the later blow of NHI-related taxation - which will likely be introduced in the 2017-2018 Budget to fund the scheme’s expansion.

He also slammed the Government for implying that healthcare services could be provided ‘below cost’ under NHI, querying how it could give this impression when it still did not know the plan’s total costs.

Responding to Tribune Business’s latest NHI revelations, Dr Sands said:”It is so obvious that the Government is taking $31 million of tax money to basically cajole, persuade’ or bribe - depending on the word you want to use - the public and physicians to sign on and buy into this programme.

“But come July 2016, you don’t know how much they’re going to put in the Budget in terms of taxes to extract from your backside to pay for this.”

A Government discussion paper for Monday’s meeting with the Medical Association of the Bahamas (MAB), obtained by Tribune Business, revealed that a $31 million budget has been deemed sufficient to cover National Health Insurance’s (NHI) first three months.

That figure is broken down into the $25 million deemed essential to cover all primary healthcare costs that will be incurred, plus a $6 million ‘reserve’ that will cover any cost overruns.

This newspaper also disclosed how the Government appeared to offer certain ‘concessions’ to address the MAB’s concerns, agreeing that NHI’s preferred Patient Centre Medical Home (PCMH) model would no longer be “mandatory”.

The Christie administration also agreed that Bahamian doctors did not have to sign-on to NHI’s preferred ‘capitation’ method of compensation, and could elect to accept fees for their services - before then outlining ‘the catch’.

It offered Bahamian doctors numerous ‘financial sweeteners’ to implement the PCMH, which will not be available to colleagues retaining their existing primary care model, including “up front” payments, “subsidised” medical malpractice insurance, “start-up funds” and performance-based bonuses.

Assessing all this, Dr Sands told Tribune Business: “It really suggests that if we need incentives for this programme, there’s something wrong.

“Why is it, although there’s an economy on the brink of a downgrade [to junk status], that we find ways to spend money unnecessarily?

“If this programme is as good as it’s supposed to be, why don’t they come clean and with the Bahamian public and say to them: This is what the programme’s going to cost, and what we’re going to spend.”

The Government has yet to place a final ‘price tag’ on NHI, or determine the healthcare services that will be covered under the Vital Benefits Package - the scheme’s basic level of coverage, which is likely to be introduced towards the end of 2016 or in early 2017.

“To give people a $31 million foretaste for three months,” Dr Sands added, “you’re simply saying: ‘Take it, use it and we’ll start to bill you for it in a few months’.

“Once you’re there, you’re hooked. How many people, having had an opportunity to sample the goods, will want to go back to what they had?

“It speaks to a level of gamesmanship in what ought to be a very direct, honest and transparent process. People aren’t feeling this, so let’s give them a nice little teaser sample, get them hooked and, once they’re hooked, we’ll stick it to them,” he continued.

“It’s not only the public; it’s the physicians. They’ll see patient flows through their offices like they’ve never seen before, with no deductibles, no VAT, no nothing.

“Every physician will have the opportunity to have a full office for three months. If I don’t find that to be the most wonderful thing since sliced bread, I’m an idiot.”

Dr Sands questioned where the $31 million allocated for NHI’s first three months of primary care was coming from. He asked whether it was contained in the existing healthcare Budget, or was coming from VAT revenues.

“It’s a very interesting approach that is being taken, and the secrecy is something that all Bahamians should be very concerned about,” he said, adding that the uncertainty over how much NHI will cost, and who will pay for it, was making it impossible for businesses and households to budget.

“Come on guys, there’s a total lack of transparency with this approach to governance in the dark,” Dr Sands told Tribune Business.

“One can only summarise that this is about politics. We’re going to do everything we can to make people believe we are the kindest, gentlest government to hit the Bahamas because we gave them this wonderful thing called NHI.”

Dr Sands said many Bahamians were likely to be “quite angry when they wake up and realise they’ve been sold a bill of goods”.

And he criticised the Government’s “rhetoric” for suggesting that NHI would result in some healthcare services being provided at ‘below cost’.

“I’d like to know how they will provide healthcare at less than cost when Government doesn’t know what it costs to provide that level of healthcare,” Dr Sands told Tribune Business.

“The Government will wave a magic wand, and the cost of healthcare goods and services will drop.”