The Tribune

By TANEKA THOMPSON

Tribune News Editor

tmthompson@tribunemedia.net

DEATH rates for patients at the Princess Margaret Hospital’s public wards are more than 100 per cent higher than those of patients in the facility’s private wards, a report prepared by international accounting firm Sanigest Internacional found.

The report also found that PMH’s average mortality rate, 4.6 per cent – which excludes the death of infants – is “well above the US average mortality rate of 1.3 per cent.”

The report, of which The Tribune has obtained a copy, was presented to the government on October 2, 2014 and examines the feasibility of National Health Insurance (NHI) and presents options for financing the scheme.

According to the report, mortality rates are “well over” 100 per cent higher in PMH’s public wards for persons aged 18 to 64, as well as for those individuals 65 and older.

Data from the report shows that in 2012, death rates of people aged 18 to 64 admitted to PMH’s public wards was 2.7 per cent compared to a death rate of 0.5 per cent for those of the same age range in the private wards.

Meanwhile, people 65 years and older had a death rate of 14.8 per cent in the public wards compared to a rate of 6.9 per cent in the private wards.

Those younger than 18, excluding newborns, had a death rate of 0.7 per cent in public wards while there were no deaths for this age group in PMH’s private wards.

Patients who are admitted to PMH’s private wards have to pay for health care while treatment is free in the public wards, which are often overcrowded.

“There are a variety of reasons for this including greater severity in illness at admission for public patients, and likely a high rate of emergency admissions to public wards (source of admissions is not known for PMH data),” the report notes. “However, given that the data are adjusted for age (it is not possible to adjust for diagnosis severity due to the coding issues) it is not likely that the differences in severity are that extreme to explain a doubling of mortality rates.”

The report also noted that data from the Department of Statistics 2013 Household Expenditure Survey shows that poorer households are less likely to have private health insurance and in general people in lower income brackets without private health insurance will be unable to afford to access care in PMH’s private wards.

“As such, there is a clear issue with equity in access to care which is providing higher outcomes,” the report said.

The report adds that, over time, NHI is expected to address this issue and create “additional equity” by increasing access to health services for some of the lower socioeconomic groups in the population; promoting a primary care model approach which should result in less hospitalisations and incentivising the public sector to improve the quality of their services.

The Bahamas spends on average $780m a year on health care in both the private and public sector – one-tenth of its entire economy – putting health care spending among the highest levels anywhere in the Caribbean or indeed, the developed world, the report said.

As reported previously, the government’s consultants have said implementing NHI could cost between $362 million and $633m. The lower figure represents costing for a basic benefits universal health care plan while the higher figure would apply to a health care scheme with more expansive benefits.

The report also outlines various measures that can fund the plan.

These range from a one per cent payroll tax to fund the National Insurance Board’s National Prescription Drug Plan and placing higher taxes on car insurance policies.

Another scenario suggests raising the NIB’s wage contribution ceiling; placing higher taxes on liquor and tobacco to fund NHI or a instituting a new five per cent pay roll tax to pay for the plan.

The government has said it plans to roll out NHI in January 2016.