The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Bahamian doctors have warned that the Government’s current National Health Insurance (NHI) proposal is “flawed and unsustainable”, and could result in “poor and unethical medical care” if implemented as is.

The withering assessment is said to be contained in the Medical Association of the Bahamas (MAB) position paper on NHI, according to physicians and doctors who have seen it.

The disclosures came as several doctors, again speaking on condition of anonymity, told Tribune Business that the Government’s NHI numbers “don’t add up or jive”.

They argued that if the Bahamas was to match the likes of Canada on annual health expenditure per person, this nation - with its relatively high living costs and per capita income - should be spending “over $1 billion on healthcare annually.

Yet the Christie administration and its Costa Rican-based consultants, Sanigest Internacional, are arguing that the Vital Benefits Package - the basic level of insurance and health services to be offered under NHI - will cost just $400 million.

This, one physician told Tribune Business, is despite the fact that the Sanigest NHI model is based largely on the Canadian health system - where per capita spending is at least double that of the Bahamas.

Tribune Business was told that the MAB position paper, which is understood to have been generally agreed by most members, also warns that the wider Bahamian economy cannot support the proposed NHI model.

“The Bahamas has gone through significant economic upheavals in the past few years and our unemployment rate remains high. With a GDP growth rate of less than 2 per cent and an aging population, creating a financially sustainable system will be a challenge,” was how one source described the MAB document’s contents.

Tribune Business was told that the MAB is against the Government’s policy to force all Bahamians with existing private health insurance plans to drop that coverage, and instead enroll for the NHI Vital Benefits Package.

It is also understood to be arguing that Bahamians should be able to choose how their healthcare is financed, whether via an NHI scheme or private health insurance.

Yet there are also areas of ‘common ground’ between the MAB and the Government. The doctors reiterate their backing for Universal Health Coverage (UHC), although not the proposed NHI model, and also agree that age and pre-existing medical conditions should be no barrier to obtaining some form of health insurance.

However, the MAB is also understood to be calling for a “more efficient and effective” use of resources in the public health system, along with technology, systems and electronic records upgrades.

And it wants to see some form of catastrophic health insurance coverage addressed under any NHI scheme.

“After we met with the Government, we said this is pretty much what we believe in, and would like to move to a health system like this,” one doctor, speaking on condition of anonymity, told Tribune Business of the MAB proposal.

They added that the NHI model proposed by the Government was massively underfunded if it was seeking to bring Bahamian health care spending into line with Western Hemisphere nations that had similar per capita incomes.

With the Bahamas enjoying the third highest per capita income in the Western Hemisphere, and relatively high living costs, the doctor added that this nation should be compared to the likes of the US and Canada when it came to analysing healthcare quality and spending - not its Caribbean and Central American counterparts.

“The system that Sanigest has designed will not work in the Bahamas,” the doctor told Tribune Business. “We do not have the finances for it.”

With a roughly $8.5 billion gross domestic product (GDP), and the Government pegging healthcare spending at 9.7 per cent of GDP, the doctor said this translated into the Bahamas spending around $820 million per year on healthcare.

This expenditure is split 50/50 between Government and private sector, and equates to around $2,000 per Bahamian per annum - a figure similar to statistics presented by Sanigest.

The doctor, though, pointed out that the Bahamas’ per capita healthcare expenditure was less than 50 per cent of Canadian healthcare spending.

‘”The Canadian government spends $4,200 per annum, which this year looks like $6,000,” the source told Tribune Business. “If we were spending $4,000 per Bahamian, which is the level it should go up to, the total healthcare spend would be about $1.55 billion.

“If the Government takes over our healthcare system, you’re looking at over $1 billion in government spending. The numbers don’t add up or jive. Where is the Government going to get this money from? They’re quoting their figures based on an underfunded system.”

The doctor added that the Bahamas’ multi-island geography was not well-suited to Sanigest’s plan, and reiterated the MAB’s demand for “fundamental changes to the Government healthcare system” before any moves are made to implement NHI.

Emphasising that the private healthcare system simply did not have the capacity to cope with the increase in patient numbers that NHI is demanding, the doctor added: “We have said to the Government time and time again: Clear up your own house.

“There’s no way this [NHI] can work unless you have your system working properly. Government needs to run it like the private sector.

“It’s just not run properly. It’s just a litany of mistakes and errors that takes place,” they continued, “a lack of equipment and a lack of care that makes Government healthcare so problematic. They’re not in the new world of electronic records.

“The fear is we go to a new system when we can’t take care of people in the country through the Government system.”

The doctor said the Christie administration’s attitude towards NHI implementation seemed to be: “We’ll destroy half of what’s good to give everyone something, come hell or high water.”

Acknowledging that the ‘good half’ was the existing private healthcare and insurance sector, they also compared NHI to “putting square pegs in round holes”.

Given the sluggish Bahamian economy, the doctor instead urged the Government to better use its existing resources to tackle healthcare problems, rather than embark on NHI’s ‘tax and spend’ approach.

They reiterated that private physicians were willing to shoulder a small increase in patients to relieve the public system’s burden, but not to the extent demanded by NHI.