The Tribune

By NICO SCAVELLA

Tribune Staff Reporter

nscavella@tribunemedia.net

A LEADING surgeon has warned that the current model of National Health Insurance will create a “huge problem” in soliciting productivity from private physicians and could foster behaviour “that resembles the typical civil servant”.

Dr Duane Sands, a cardiothoracic surgeon and former Free National Movement senator, said turning private healthcare professionals into “employees of the state” would ultimately promote a “clock-watching” mentality among healthcare practitioners. He said such an attitude is anti-ethical to the ideals of good doctoring and prevalent among some trade union members.

Dr Sands added that if physicians are stripped of their “professional autonomy” they will no longer strive to “go the extra mile” in providing quality healthcare for patients, which he suggested will ultimately undermine the core purpose of universal healthcare coverage in the country, which is to provide quality, affordable access to healthcare for all Bahamians.

“You now make physicians employees of the state, no different from any other civil servant, and you’re going to start to see an increasing level of behaviour that resembles the typical civil servant,” Dr Sands said during a recent interview.

“The idea of personal autonomy or professional autonomy is a very important thing when you’re talking about doctors, lawyers, architects, accountants, etc. When you make those professionals civil servants across the board, now you have really created a huge problem in productivity.”

Dr Sands predicted that there will likely be a “honeymoon period” for physicians, a two-year period during which doctors will be presented with an “inducement” that will suggest that working under NHI trumps being a private physician. However, he said things will go “rapidly downhill” once the realities of budget adjustments and the “financing nightmare” surrounding NHI sets in.

According to Dr Sands, primary care physicians, as well as nurses working in the private sector, have tentatively been promised $36,000 per annum under NHI. The specialist doctors he said have been promised $100,000.

As it stands, every consultant doctor makes basically the same wage: $48,000 per annum, in addition to an “on-call allowance” of $12,000 per year, according to Dr Sands.

Physicians with consultant status have the capacity to bill patients in the private sector, thus varying the salaries that those physicians may earn, he said.

However, Dr Sands said that the NHI model that government is currently contemplating will also mandate physicians to see patients on average for three 15-minute sessions per year, regardless of the reasons for the visit, essentially outfitting private physicians with a fixed salary and fixed range of responsibilities and “autonomy”.

However, the irony in such a proposal, Dr Sands explained, is that while what is proposed is more than what the average Bahamian currently enjoys and/or receives, it is “dramatically worse than what people who currently have insurance are getting.”

“So what we’re saying is, that in this social redistribution experiment now, we’re not going to raise the average Bahamian up to the level of private healthcare; we’re going to bring everybody down to an unacceptable level,” he said.

“And as a consequence now, in exchange for saying that we have equity – wonderful word – and parity, another wonderful word, and access, the fact that you have to wait three months or six months or nine months to get it, well that’s only fair.”

Dr Sands said the government will likely employ a “divide and conquer” strategy in trying to convince physicians to sign onto NHI, starting with the primary care physicians before tackling the more “truculent” specialists, thus “boxing in” the latter group.

“They can get past the employers, they can get past the insurance companies, but what they cannot get past is the doctors,” Dr Sands said. “But fundamentally, the negotiation where a contract is put to the doctors to say ‘are you prepared to do this, are you prepared to work this way, are you prepared to change your professional behaviour because you agree that this is the right thing to do,’ the only way that physicians would be prepared to do that is if they agree within their heart that what is being done is indeed in the best interests of Bahamians.

“This becomes a very difficult thing for the government, because on the one hand they say ‘thank you for your service,’ but then on the other hand they call you a ‘greedy doctor’.”

NHI will be phased in over a five-year period, officials have said.

The first phase involves registration and improvement in public health infrastructure.