The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The draft National Health Insurance (NHI) Bill has been slammed for providing the Government with “sweeping invasion of privacy powers” that threaten the confidentiality of doctors’ patient records.

Dr Duane Sands told Tribune Business that the proposed legislation enables the NHI Authority to access physicians’ records without placing limits on what it can see, or how the data is used.

Describing the powers contained in the draft Bill as “intrusive”, the FNM’s Elizabeth candidate asked “what’s next” if it passed into law without being amended.

“There are some stipulations in that [Bill] as it relates to the powers of the Authority,” Dr Sands said, outlining his concerns.

“They give sweeping powers to do intrusive invasions of privacy concerning sensitive private data within a physician’s office.”

Dr Sands’ concerns focus on the draft Bill’s section 33, which gives the Authority the ability to inspect doctors registered with the scheme as healthcare providers.

The clause reads: “The Authority may, for the purposes of supervising providers participating in the plan, inspect the equipment and premises, business and affairs, including the procedures and information technology systems of a provider.”

And it also permits the Authority to “examine the claims, data and accounting records in the possession of a provider”.

Doctors, much like attorneys, have a strict duty of confidentiality when it comes to the medical records of their patients given that, in many cases, the information is highly sensitive and personal in nature.

Yet the Bill appears to contain no limitations on what data can accessed by the Authority, nor how it will be used and/or stored.

Dr Sands summed up the implications thus: “Allowing access to a computer system without rigid limitations on what they’re allowed to see; billing data, collections data etc.”

He added: “If this type of thing is allowed to stand in a democratic country, and that type of intrusive behaviour stands, what is next?

“They say the road to hell is paved with good intentions. It’s all well and good to say this is being done for the public good, but you have to be very careful, especially with the training of those people given these powers.”

It is unclear whether section 33 has already been modified. Damara Dillet, the Secretariat’s attorney and legal consultant, recently said the draft Bill’s release for public consultation had been delayed, after changes were suggested by doctors and the wider medical community.

Ms Dillet said the legislation had gone “back to the drawing table”. The Bill, as it currently stands, requires all doctors registered as NHI providers to maintain records on benefit payouts, claims and financial records.

It also mandates that doctors provide it with documents upon request, although records covered by “legal professional privilege” are exempt from this.

Doctors will also have to submit monthly reports on the patient treatments they have rendered, and the outcomes. These reports will also include financial and patient usage data.

The Government has also yet to publish the regulations accompanying the NHI Bill. These usually give legislation its ‘enforcement bite’, and it is possible these will place limits and safeguards on how the NHI Authority accesses, and uses, doctors’ data.

Dr Sands, meanwhile, said the language employed in the draft NHI Bill was “inconsistent” with existing legislation, especially the Healthcare Licensing and Facilities Act.

And he warned that the Government would need to soften the clause making it mandatory for all Bahamians and legal residents to register for NHI, otherwise it may face “significant push back” from those with existing private insurance plans.

The draft Bill’s sections 16 and 17 stipulate who is eligible to register for NHI, and state: “Every person who is eligible for the plan must enrol in accordance with prescribed regulations.”

Dr Sands described the National Insurance Board’s (NIB) current ‘smart card’ registration drive as “a surrogate for NHI registration”, as the latter cannot begin until the legislation is passed into law.

Describing the mandatory nature of NHI registration as “a big sticking point”, he told Tribune Business: “The language has a number of people spooked.

“The mandate for registration and participation in NHI creates a real moral and social conundrum. You’re being forced, some people with high quality third party payer [private insurance coverage], to register and participate in a product that may be worse than what they have now.”

Dr Sands said NHI’s mandatory nature created a real dilemma for many of the 100,000 Bahamians currently enjoying private health insurance, as many would likely elect not to participate if they had the freedom to choose.

“For NHI to work, there has to be near universal participation,” he explained. “The Government says they want to use a carrot, but it’s likely they’re going to have to use a stick.

“That stick is going to cause more damage to the Government. They’re going to have to figure out how to word that mandate such that they don’t get such significant push back that they only end up with the high risk, low paid population that are currently uninsured.”

Dr Sands said the NHI process would have gone much more smoothly had the Government brought all healthcare industry stakeholders into the discussion at an early stage, and engaged in meaningful consultation.

“You have people that are spooked and believe the motivation of the Government is not all pure, and that mandate may become a legal sticking point that takes a while to be resolved,” he told Tribune Business.

“Don’t be surprised if that clause pushes NHI registration beyond April. If you do the arithmetic, the Government do not have much time. It’s going to be a huge push to get this [NHI] done given the technical challenges.”

Dr Sands said the “unified” position of Bahamian physicians bodies remained that they would “stand together” in deciding whether to accept the NHI registration terms offered by the Government.

“All options remain on the table, including denial of participation,” he added. “The purpose of that is to maximise the likelihood of reasonable dialogue, a reasonable exchange and a reasonable consultation.

“If that occurs, and the final recommendations do bear in mind our concerns, then we see no reason why physicians will arbitrarily or capriciously hold out.

“But if we believe this is not in the best interests of Bahamian patients and their welfare, we are duty bound not to sign it.”