The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Government was yesterday said to have dropped its National Health Insurance (NHI) requirement for private doctors to take on 5,000 patients, although it has yet to address 18 concerns raised by the Medical Association of the Bahamas (MAB).

A well-known doctor, speaking on condition of anonymity for fear of victimisation, told Tribune Business that the 5,000 patient number had likely been dropped because it had failed to entice MAB members to sign up for NHI’s preferred care model and payment mechanism en masse.

With a $212 per patient, per year fee proposed as compensation for primary care physicians, the doctor said that coupled with the 5,000 patients, this promised doctors just over $1 million a year in revenue.

Tribune Business’s doctor source said this was a significant inducement to private physicians struggling with an insufficient client base, and suggested it was part of the Government’s ‘divide and conquer’ tactic with the medical community.

“They’ve dropped the 5,000 number, and have not decided how many we should take now,” the doctor told Tribune Business.

“We were never going to be able to take care of that number. It’s a stupid number. It was pulled out to entice us in.”

The doctor added that the Government had initially talked about private primary care physicians taking on 3,000 persons per practice under NHI, a figure they described as a “more reasonable number for us to take care of”.

However, they emphasised that the Government had confirmed no new ‘patients per doctor’ figure, and suggested it was becoming “jokey again” with just weeks left before NHI’s registration start.

That is supposed to kick-off on Monday, January 18, but Dr Duane Sands yesterday agreed with Tribune Business that there was nothing in the 2009 NHI Act that made registration for the scheme a mandatory legal requirement.

The Prime Minister has indicated that new enabling NHI legislation will be crafted and passed within the next three months, but in its absence Dr Sands questioned whether it was legal to use National Insurance Board (NIB) data for the scheme - something he believes is not supported by the NIB Act.

Meanwhile, the MAB remains concerned that the Government has “condensed” what is supposed to be a one-two year NHI implementation timetable into just one month.

This was among a list of 18 concerns raised during a meeting between the MAB and NHI Secretariat, which was chaired by Dr Bernard Nottage, minister of national security, earlier this month.

The list, obtained by Tribune Business, reveals: “[MAB] members expressed apprehensions about the eight steps to NHI implementation being condensed to a timeframe of approximately one month, when originally it was forecasted by Sanigest to take one to two years.

“The timelines appear to be inconsistent with what seems to be achievable.”

While emphasising that it wanted to partner with the Government on NHI, and “compromise” for the public good, the MAB - according to the Government response - warned “that effective communication, trust and negotiations must be fostered to bring about the success of NHI implementation”.

The Association warned the Government that it unsure whether the insurance industry would offer supplementary benefits packages under an NHI scheme, and pointed out that the existing insurance plans for Government workers were “currently superior” to the proposed NHI primary care packages.

“Trade unions have requested that the overseas referral benefit remain as part of their insurance plans after the NHI rollout,” the Government’s report on the MAB’s concerns stated.

“Notwithstanding, government’s position has been that this benefit will be removed from the group insurance policies. MAB queried as to whether the Government will reconsider allowing this benefit to remain in place after the roll-out of NHI.”

The document concedes that the MAB “is not in support of many of the key decisions put forth” by NIB’s Dr Kevin Bowe, and the Government’s NHI permanent secretary, Peter Deveaux-Isaacs.

Further concerns related to a “lack of systems control and monitoring to eliminate wastage, as well as the utilisation of services as many persons will take advantage of healthcare services during the roll-out”.

The MAB also warned that increased public access to healthcare would lead to “an increase in exposure” to malpractice litigation, something that would require tort reform and education.

“The introduction of an electronic medical record system may prove challenging for many health care providers in terms of capital cost,” the Government’s report on the MAB’s concerns warned.

“Additionally, certain providers have made investments in acquiring such a system. It is therefore necessary that medical and allied professionals engage in discussions with the NHI Taskforce on how the merging of current system and investment of new systems will be achieved.”

The MAB also called for physiotherapy legislation to be rolled out prior to NHI’s roll-out, “in an effort to mitigate unlawful practices an to improve the quality of care that is being provided within the profession”.