The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A well-known physician yesterday suggested primary care doctors may “cut their own throat” if they sign up to the preferred National Health Insurance (NHI) model, as he questioned whether the Government’s numbers “make sense” for the Bahamas.

Dr Duane Sands, the former FNM Senator, speaking after the medical community and allied professions met with senior government officials and consultants over NHI yesterday, confirmed that primary care doctors were being offered an annual capitation fee of $212 per patient.

They are also being asked to take on up to 5,000 patients per annum which, based on the figures, would enable Bahamian physicians to earn more than $1 million per annum in total revenues.

Dr Sands told Tribune Business that this seemed like “a sweet deal” for doctors, but queried whether these numbers had been “independently verified” as appropriate in the Bahamian context.

This was especially given that private primary care providers were essentially being asked to become “servants of the state” if they signed up for NHI’s preferred capitation method.

Another doctor, speaking to Tribune Business on condition of anonymity, backed Dr Sands’s position, explaining that the Government wanted the profession to “take on the risk” of extra patients when the likely NHI health sector usage rates were unknown.

They, and Dr Sands, suggested that yesterday’s meeting was ‘more of the same’ in terms of offering inducements to soften up the medical profession, and sweeten them into accepting - and signing up to - the preferred NHI model.

Tribune Business last week revealed how the Government has promised the Medical Association of the Bahamas (MAB) that its preferred Patient Centre Medical Home (PCMH) model will “not be mandatory”.

The Government’s discussion paper for a meeting with the MAB earlier this month, which was obtained by Tribune Business, also promised that doctors could opt not to be paid for NHI-related services via the capitation method - a set annual per patient fee.

But the Government briefing paper contained a ‘sting in the tail’ for any doctor wanting to be compensated by NHI on a ‘fee for services’ basis, as opposed to the preferred capitation method.

It warned that Bahamian doctors who elect not to adopt the Patient Centre Medical Home (PCMH) model, and remain independent primary care providers, will “not be eligible for additional financial benefits”.

These benefits, the document says, will include “up front” payments for PCMH doctors, plus “subsidised” medical malpractice insurance, “start-up funds” and performance-based bonuses.

Dr Sands told Tribune Business of yesterday’s meeting, which was led by Dr Glen Beneby, the chief medical officer, and Sanigest president, James Cercone: “What they are seeking to do, as I’ve suggested before, is offer what seems to be a sweet deal to the primary care physicians.

“It’s a hell of an incentive, but I suggest that it is not going to be a sustainable proposition.”

Confirming the capitation fee and patient figures supplied to Tribune Business, Dr Sands agreed that they “sound wonderful on the face of it”.

However, he questioned whether the $212 per patient annual fee would be sufficient to cover all treatment costs, plus nursing, other staff and all business expenses incurred by private doctors.

This, Dr Sands explained, was a particular concern when “many” primary care providers did not have the necessary systems and electronic records to determine “what their unit cost is for providing care to a patient”.

“No one has had a chance to independently verify that these numbers make sense,” Dr Sands told Tribune Business.

“If we’re going to sign a contract, on the face of it, it may seem very appealing but when you drill down into it, you may be cutting your own throat.

“Somebody independent needs to look at these numbers in the context of the Bahamian reality, and determine whether they are reasonable or not.”

Dr Sands continued: “When you’re talking about a model where every private physician is ultimately a servant of the state, because they’re going to be receiving these capitation payments, is that where we want to be?

“Would the lawyers accept that? Would the accountants accept that? Would the architects accept that? It’s all well and good to claim that it’s in the public interest, but the profession had better respond in a very deliberate and firm way before they find themselves marginalised as professional individuals.

“It’s all well and good in the name of the state that we are to change the way we live, and we don’t have a choice. Or we do have a choice, but they’ve made it so outrageous that if we want to eat we had better come this way.”

Dr Sands also expressed concern that he and others harbouring NHI concerns would be made to appear “afraid of change” and against “progress for the majority”.