The Tribune

By NATARIO McKENZIE

Tribune Business Reporter

nmckenzie@tribunemedia.net

The National Health Insurance (NHI) scheme’s project manager yesterday said almost 70 per cent of physicians who attended last week’s briefing sessions had indicated they would accept its proposed fee structure and sign-up as care providers.

Dr Delon Brennen, speaking at a press conference at the NHI Secretariat’s headquarters, said: “The physician providers who were actually in the sessions, and have been a part of the actual discussions, have actually responded very positively.

“In our exit surveys, 70 per cent of them have responded to say that not only are they accepting of the fee structure, but they re willing to sign up and be a part of NHI Bahamas as we go forward.”

Dr Brennen’s comments directly contradict those of physicians who attended the New Providence provider sessions on December 6-7, with two other meetings held on Grand Bahama and Abaco on December 8.

Numerous doctors, speaking on condition of anonymity, told Tribune Business that the capitation fee structure unveiled by the NHI Secretariat would leave many struggling to cover their overhead expenses.

And, in potentially forcing many practices into a loss-making position, and having to potentially downsize staff and cut other costs, they warned the Government’s proposals threatened to compromise healthcare quality for Bahamians.

These doctors suggested the NHI architects were trying to impose a “70 per cent across-the-board” fee cut, and squeeze everything into the $100 million budget allocated by the Government.

And one physician said: “No one we have spoken to has agreed to provide services at this point in time.

“No one wants to sign up for something that is not going to work. They’re hell bent on doing something that we feel as a medical group is not in the best interests of the country.”

They added that the Medical Association of the Bahamas (MAB) and its members had yet to even see a proposed contract to provide services under NHI, and there was “no way to have a relationship” with the scheme.

Dr Sy Pierre told Tribune Business that the NHI Secretariat had promised that doctors would be able to register online to provide care under NHI. It had also suggested that “the final proposal” for physicians would look “very different” to the one that exists now.

Without the participation of private primary care doctors, NHI cannot come into being because there simply will not be enough providers to cover a 360,000-strong population and reduce the burden on the existing public healthcare system.

“We know that there has to be a critical mass of providers available for us to be able to deliver services. What we look to do now is really try as much as possible to include all providers, primary care providers,  into that number,” said Dr Brennen.

Therefore, obtaining the ‘buy in’ of doctors is crucial for the NHI Secretariat. There are concerns, though, that the doctors likely to sign up for NHI will be those who are less successful and have smaller patient populations, potentially compromising healthcare quality.

 Dr Brennen yesterday said there were more than 1,100 physicians in the country, although not all of them are primary care providers.

“What we are really looking at is how many primary care providers have been exposed to this information,” he added. “We have met individually with approximately 100 of those primary care providers to give them direct information. We have made the information available to many more of them through social media outlets, e-mail and direct mailing to them.

“We have a large segment  of the primary care provider community that has been exposed to the information, but we invite them to either come in or have us go to them to present to them one or one in small groups to explain the model.”

Dr Brennen said one option for physician reimbursement was to become a Fee-For-Service primary care provider, where doctors will be paid using a simplified fee schedule.

“This fee schedule has been developed in a way to ensure that it aligns with current practice patterns among local primary care physicians, as well as leading practices in other jurisdictions with mature primary care models,” he said.

“Extensive research analysis was completed to ensure the proposed fees are fair to providers, and also responsible from the perspective of the Government that should always keep the public interest in mind.”

Dr Brennen added that a second option is a capitation model, where physicians will be reimbursed a set fee for each individual who signs up to be in their patient population.

“Capitation payments will allow the Bahamas to move to a value-based model, which is the leading practice across the world, and would drive health improvements by incentivising team-based care, prevention and wellness,” he said.

“The capitation rate for each patient will be different based on a  patient’s age, gender and location. The proposed NHI Bahamas capitation rates also includes  a 25 per cent  premium  compared to the Fee-For Service model to incentivise primary care physician providers, and expedite our journey to a value-based health care financing model.”

Dr Brennen continued:     “A third option is to sign-up for NHI Bahamas maternity care or infant care bundles, where physicians will be reimbursed for a package of services that are determined to be essential for pregnant women and infants up to two years of age.

“Primary care physician providers who are on a fee-for-service or capitation model can also receive bundle payments if patients sign up with them for the duration of the pregnancy or for their newborns.

“The reimbursement  model has been designed according to what the Bahamas can afford as a country, and is in alignment with international best practices.”

The NHI Secretariat’s permanent secretary, Peter Deveaux-Isaacs,

said 240,00 Bahamians have their NIB smart cards in preparation for the roll-out of NHI services.