The Tribune

A well-known physician yesterday expressed concern that National Health Insurance (NHI) could create “a dumbing down” in healthcare quality in the Bahamas, and likened the gap between the Government and private sector to “a chasm”.

Dr Duane Sands, speaking after he attended a meeting between the private sector and the Government’s NHI Secretariat and implementation team, told Tribune Business it was obvious none of the agreements necessary for a successful launch were in place.

He added that the volume of patients who doctors are expected to take on under NHI, 5,000, could result in fewer patient visits and quality of care for some Bahamians.

“Let’s just say it was pretty heated. It was a less than auspicious occasion,” the former FNM Senator said of yesterday’s meeting. “What is clear is that when you look at the various stakeholders, with whom there has to be agreement for the successful implementation of NHI, there has been nothing signed.”

Dr Sands said this was despite NHI’s roll-out “ostensibly” being two weeks away, and he added: “Many of the stakeholders questioned the validity of the assumptions used to arrive at this proposal. The gap, the chasm, is huge; it’s wide.”

Dr Sands, via a ‘back of the envelope’ calculation, estimated that NHI could result in restricted doctors’ visits for some patients, due to the volume of persons they will now be required to care for.

Using 15 minutes as the average time a patient will spend with their doctor, Dr Sands estimated that a Bahamian primary care physician would only have time for 15,000 consultations per year.

With 5,000 patients, Dr Sands said this would translate into an average of three patient visits per year - even though some may need to see their doctor more.

“They will take all primary care,” he explained of the Government and NHI. “It means that on average, if you are a patient in the Bahamas, NHI intends to give you an average of three 15-minute visits per year.

“We accept that not everyone is going to go to their doctor, but we’re trying to elevate the quality of care every Bahamian gets.”

Dr Sands said primary care doctors treated patients for a wide variety of ailments, ranging from coughs and colds to hypertension and diabetes.

He emphasised that persons with major medical insurance frequently visited their doctor for annual medicals and maintenance check-ups - treatments that would exceed the estimated three visits per year by themselves.

“What is that going to do to waiting times, the quality of care and physicians and burn out?” Dr Sands said of NHI’s impact. “This is a quality concern.

“It now makes sense that you’re [NHI] only paying $212 per patient, per year because what we get in return is not something we’re going to be particularly proud of.

“The quality in terms of what we’re going to be providing our people, if you’re now saying you want to manage the whole shooting range, sounds like we’re going to be dumbing things down.”

Other private sector stakeholders present at yesterday’s meeting, and speaking on condition of anonymity, told Tribune Business that the Government’s NHI consultants, Sanigest Internacional, said they were “comfortable” with cost estimates for the scheme’s first year despite lacking any data to make such calculations.

Tribune Business previously reported how the Government and private health insurers’ failure to agree the terms of a Non-Disclosure Agreement (NDA) meant that the latter had supplied no date for PricewaterhouseCoopers (PwC) NHI costing exercise.

The accounting firm had also previously said there were no reliable data sources in the public sector they could draw on, either, implying that it is virtually impossible to accurately price the NHI scheme.

One source, speaking on condition of anonymity, told Tribune Business: “We were advised today by the Government’s consultants, Sanigest, that as far as primary health care costing is concerned, they are comfortable with the numbers they have collected, even though they have not received numbers from the private insurers.

“It seems they may have received aged data from one of the insurers, and extrapolated that for the whole population..... One thing is certain from the meeting today; they’ll be proceeding as planned.”

The source added that the private insurance industry remained particularly concerned about the Government’s plans to create a publicly-owned insurer for NHI, called Bahama Care.

This plan was yesterday compared to the Bahamian aviation industry, where the Government is also regulator and an operator via its ownership of Bahamasair.

“How do you compete?” the source asked. “It just highlights the concerns.”

The Government team at yesterday’s meeting included NHI permanent secretary, Peter Deveaux-Isaacs; Dr Glen Beneby, chief medical officer; his deputy, Dr Delon Brennen; Kevin Bowe from the National Insurance Board (NIB); and James Cercone, head of the Government’s consultants, Sanigest Internacional.

The private sector stakeholders present included the major insurance industry players, the pharmaceutical sector, the Bahamas Chamber of Commerce and Employers Confederation (BCCEC) and Medical Association of the Bahamas (MAB).