The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Two Cabinet ministers set to play a key role in National Health Insurance’s (NHI) implementation helped to author a paper 37 years ago that advocated a much different approach to reform, and concluded: “Government cannot finance everything.”

Dr Perry Gomez, minister of health, and Dr Bernard Nottage, minster of national security, are both named as ‘contributors’ to a 1978 Medical Association of the Bahamas (MAB) paper that effectively called for a public-private partnership approach to healthcare reform.

While the document, obtained by Tribune Business, does refer to a ‘National Health Insurance Plan’, it makes clear that this would only assist those Bahamians for whom “cost is an obstacle” - meaning those who were unable to obtain private health insurance.

The report, written while Dr Nottage was MAB president, and Dr Gomez, its secretary, urges that “a balance be struck” between government funding and private health insurance - exactly the reforms sought now by doctors, insurers and the private sector.

Billed as ‘A Healthcare Philosophy for the Bahamas’, the MAB paper also illustrates just how little progress the Bahamas has made in almost four decades - and under both PLP and FNM administrations - in producing a more effective, and efficient, healthcare system.

Its summary of the nation’s ‘health status’ lists many of the concerns raised by the current Christie administration’s consultants, Costa Rican-based, Sanigest Internacional, namely that the Government was not getting ‘value for money’ and that the health outcomes statistics were “below potential”.

This again suggests that throwing more money at the problem will have little effect, and NHI will not have the desired impact unless accompanied by other essential reforms, such as strengthening the existing health system infrastructure.

The contents of the 1978 MAB report suggest that Drs Gomez and Nottage have radically rethought their position since transitioning from the private sector to politics and the Government.

Dr Gomez headed the first Christie administration’s Blue Ribbon Commission on NHI, while Dr Nottage was minister of health with direct responsibility for the scheme during the period 2006-2007/

They both now sit on the ministerial committee charged with overseeing a scheme they, and the MAB, had somewhat different views on in 1978.

In analysing the role that the Bahamian government should play in healthcare funding, the MAB paper contrasted the UK’s “socialised medicine” and National Health Service (NHS) system with the market, private sector-driven approach in the US.

It concluded that a mixture of the two was appropriate for the Bahamas, acknowledging that the Government would need to “take responsibility for the personal health” of those who could not afford to take care of themselves - the poor and elderly listed as two examples.

However, the 1978 MAB report stopped well short of advocating that the Government take over responsibility for financing healthcare for 100 per cent of the population - as the current NHI scheme is seeking to do.

In words that will resonate today, the MAB said: “As a result of the British experience, it is not recognised that in our economic system, no government should, or can, undertake to finance everything.

“No country, even if prepared to pay the taxes, can supply everything..... A balance must therefore be struck between Government funding of personal health services for indigents and other special groups such as the aged, and private funding through insurance and allied agencies.”

This was how the MAB proposed to embrace universal health coverage in 1978, with its warnings about health system performance also mirroring concerns being raised now.

Its paper from 37 years ago warned that health statistics were “incomplete and inadequate”; that health personnel were too concentrated in New Providence; and that healthcare was the focus of “generous” spending.

Healthcare outcomes were also deemed “below potential”, with the Bahamas “comparing unfavourably with other countries in the Caribbean with less resources”.

And, finally, in another statement that will resonate in 2015, the MAB’s 1978 paper said: “The Government is not getting its money’s worth in terms of reduced morbidity and mortality.

“This suggests that health resources could be administered more efficiently...

“Until there is a comprehensive organised health system, serving the majority of the people, and especially those at the greatest risk, the health system will remain inefficient, wasteful, a source of frustration to the health workers, and will not make an optimal contribution to the development of the country.”

The MAB’s 1978 paper also called for a ‘decentralised’ health system where every island could provide the “majority” of needed services.

It added: “The geography of the Bahamas lend itself beautifully to this concept.” However, NHI appears to be going in the opposite direction with a centralised model, overseen by a National Health Insurance Commission as the ‘sole payer’.

Further addressing the Government’s role in healthcare, the MAB of 37 years ago also urged that the Ministry of Health “promote interaction” between the private and public sectors and long-term planning - again, something that the doctors and private sector are now demanding.