The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A withdrawal by the Medical Association of the Bahamas (MAB) and its members of all co-operation with the Government over National Health Insurance (NHI) was yesterday branded “a possibility” ahead of a crunch January 16 meeting.

Senior professionals within the medical community, speaking to Tribune Business on condition of anonymity, confirmed that the MAB was hoping “not to get to the point” of ceasing all co-operation with the Christie administration.

However, Dr Duane Sands told Tribune Business that such action remained the medical community’s “trump card” should the Government fail to deal with its multiple concerns over the proposed NHI model and how it will affect private physicians.

The MAB and its members have enormous leverage over the Government when it comes to NHI, as the scheme’s implementation is not feasible without their buy-in and co-operation.

A total withdrawal would mean there are too few doctors for the 350,000-strong population that will be covered by NHI, giving the medical community much more clout than the private insurers, which can be outflanked by the publicly-owned entity, Bahama Care.

Tribune Business understands that despite the positive ‘front’ put on by the Government and its consultants, there is mounting concern over its relationship with private physicians and whether they will be fully ‘on board’ with NHI in time.

James Cercone, president of Sanigest Internacional, the Government’s primary NHI consultant, is said to have been on the phone daily with key MAB executives in recent weeks, which some are interpreting as a sign of nervousness on the administration’s part.

The MAB has already rejected the preferred NHI care model, the Patient Centre Medical Home (PCMH), as “culturally and organisationally unacceptable” in the Bahamas.

The Association, and its members, also fear the Government’s requirement that they take on 5,000 patients per practice will dilute the quality of healthcare,and have criticised the proposed capitation payment method for their services as transforming them from carers into financial administrators.

The proposed $212 capitation fee per patient, per year, has also been slammed for vastly under-estimating healthcare costs in the Bahamas.

“What will the Bahamian people get for $212 for health care per year?” one doctor told tribune Business via e-mail.

“An annual medical exam costs more than this. What about screening testing: mammogram, Pap smears, Colonoscopy. Where will Bahamians get them done? What about Bahamians in the Family Islands?”

A senior MAB executive familiar with the NHI discussions with the Government, and speaking on condition of anonymity, suggested the Association’s next meeting with the Government - set for Saturday, January 16 - will be critical in determining its future approach.

That meeting, which will be held two days before NHI registration is due to start, is set to focus on the $212 capitation fee and the services that will/will not be included in the initial $100 million per annum primary care package.

Other issues that will be discussed, Tribune Business understands, are performance-based pay, risk adjustment, and how groups of patients with existing conditions, such as diabetes and hypertension, will be treated under NHI.

Asked whether the MAB and its members would ever withdraw all co-operation with the Government over NHI, the source said: “We hope we don’t get to that position where we don’t have to co-operate at all.

“But it is a possibility if the Government continues on the path it’s on, and doesn’t recognise we have some significant concerns with the way this is being done and the crazy numbers they keep throwing out, $212 per patient per year......

“That’s absurd. What quality of healthcare can a person get for that per year?”

The source added that, as an alternative to withdrawing all co-operation over NHI, the MAB and its members may totally reject the capitation payment method and insist they will only participate through a ‘fee-based’ system for services rendered.

“There’s no capitation; here’s what we’re willing to do,” was how they described this alternative MAB posture. “Here’s what we charge, and the various codes and consultancies we use.”

Acknowledging that the withdrawal of full co-operation by the MAB and its member doctors could effectively stymie the NHI plans, the source said the Christie administration was “banking” on private physicians who had “insufficient patient populations” signing up to the “carrot” it was dangling of 5,000 patients per year.

Tribune Business previously revealed how a Government discussion paper for a meeting with the MAB warned that Bahamian doctors who elect not to adopt the PCMH model and reject the capitation payments, 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 yesterday confirmed that the NHI Secretariat and implementation team were having multiple meetings, as many as three to four per week, with various healthcare stakeholders in a bid to ensure they were on board with NHI.

Asked whether the MAB and its members might withdraw all co-operation, the former FNM senator replied: “That is the trump card that we maintain.”

Another doctor, speaking on condition of anonymity, too, agreed that the medical community was “getting to that point” of NHI non co-operation.

“We have no interest in working with them at this time,” the source added. “They’re not being forthcoming, open and honest. They’re asking for our help, but they’re not helping us.”

Another doctor said of the January 16 meeting: “We’re not interested in having another presentation; we’re interested in the nuts and bolts of how this works.”