The Tribune

A group of Bahamian doctors has written to The Tribune to express their deep concerns and expert medical views over the government’s proposed National Health Insurance scheme.

For more than a year the doctors of the Bahamas have been consulting with the government on universal healthcare.

We have talked with many groups in the country including our patients, union leaders and the Insurance Association to name a few.

We feel compelled at this time to try and break down some of the big issues doctors have been telling the government.

We start with the fact that the government-run healthcare system is in a shambles. The hospitals and clinics are providing sub-standard service, and in buildings that are quite often rundown and in many cases unsafe.

The lower income Bahamians who typically rely on these clinics have had to suffer for years because the government, now and in the past, has not done what they needed to do to ensure that they are run properly. Knowing how the government is running our healthcare system today makes me shudder to think that any Bahamian would trust this or any government to run our healthcare system in the future.

Questions

The shining light of the Bahamian system has been the private system, where quality care can be obtained. Everybody in the Bahamas needs to ask themselves a couple of simple questions:

• Do you trust governments to run anything well?

• Are governments typically efficient or inefficient?

I can assure you that the majority of people will answer these two questions simply: we don’t trust governments and they are almost always inefficient.

With that in mind, why would you expect anything different from this new National Health Insurance (NHI) being run by the government? The doctors of this country along with others have presented our opinions multiple times. We do not believe the Bahamian government is the right entity to run the health insurance programme for this country. We feel the role of the Bahamian government should be in oversight, to create the framework upon which insurance companies work.

Have the government system fixed with the assistance from the private physicians, who have clearly demonstrated they know how to run clinics and hospitals in this country.

One major point needs to be made that differentiates our position from the government:

• We strongly feel that with the limited amount of money we have available to us in the Bahamas that we need to use that money to help the poorest members of society!

Society is made up of three major groups: those who are capable of paying for the insurance that they want to have, those who are not quite capable of purchasing private insurance for themselves and would need some assistance from the government to do so and those who do not have enough money to consider purchasing private insurance and would therefore need substantial, if not complete government support for their premiums.

We feel the money should be used to support the second and third group and not the first. This way more can go to those who need it while leaving alone those who do not need the assistance.

If the government focused on education and job creation, then they would realise as people move up the ladder of economic success they no longer need the government assistance and are capable of taking care of their own health insurance needs. This would then free up the money they were receiving for assistance to help others.

The insurance industry in the Bahamas is the entity that is best suited to manage this new system based upon the guidelines the government sets out. The system that has been outlined has too many restrictions on the movement of patients from one doctor to the next, restricts their ability to get second opinions and specialist care and - one of the biggest restrictions - they cannot seek care in the United States. We feel these restrictions are unacceptable and we cannot support a system in which they exist.

The government has not been honest with the people on the full future costing of the system they have devised. It will cost over $1 billion once fully rolled out. Our entire budget in 2015 was $1.8 billion and we were still spending more than we collected (we spent more than we took in during 2015 even with VAT).

Our unemployment level is high and our economy is growing at a very slow rate so the new taxes are going to hurt in a significant way those who are working, reducing their standard of living. Mortgage defaults are on the rise and that situation will only get worse with the new tax burden for the government’s version of NHI. This will have a negative growth effect on the economy, which hurts all of us, especially the poorest in our country.

A summary of the major problems with NHI as it stands today:

• Our inefficient government is going to be directly running the system.

• Government will be paying for the care of the most well-off individuals who do not need help, which reduces the amount of money available for the poorest in our country.

• By introducing NHI now it reduces the money available to fix and upgrade the government clinics and hospital system which benefit the poorest in the country the most, and already provides care for free.

• It is our belief that the poor will be helped the quickest and, in the long term, the most by improving the government system.

Permission

• NHI will only be available for care in the Bahamas. You will not be able to go to the United States for care unless you get permission from the government (which will be a slow and difficult process that will reduce the quality of patient care).

• The more entrenched this new government insurance becomes the more expensive and difficult it will be to purchase other insurance policies to cover private care in and outside the country.

• NHI restricts not only the movement of patients from the Bahamas to the United States, it also restricts who they can see within the country and puts government and their bureaucrats involved in patient care.

• The government giving away the first phase is purely a way to entice people to join NHI. Our current fiscal year is still in deficit, therefore we are borrowing money to pay for this initial phase, increasing our debt even further.

• The government is not being honest with people about the full cost of a fully implemented national health insurance scheme. Based on the cost of systems in the United States, Canada and the United Kingdom we can expect the government portion of spending to exceed $1 billion.

This is over 50 per cent of the current national budget.

The money will have to be found to close the budgetary gap, which will need to be in excess of the amount of money made for government by the current VAT. Such an increase in taxes will have recessionary pressure on the economy.

• The government is working with us but not listening to the major concerns we have; they have changed the small ones only in their current plan.

• The PLP have hijacked this issue for political gain. Insiders who have spoken in confidence have told us that the PLP are planning to use this issue to strengthen their chances of winning the 2017 election; that is why there is such urgency to implement NHI, not because they want to help the people.

• Currently physicians travel to the out islands to provide services. Under NHI there are disincentives to going to the patients.

You will find patients will have to go to a central clinic if they want care, which may be in Nassau. This will reduce their care, not make it better.