The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The draft National Health Insurance (NHI) Bill requires “a hell of a lot more work to bring it to life”, with one doctor arguing that its anti-fraud and confidentiality safeguards need strengthening.

Dr Duane Sands told Tribune Business that the “watered down” legislation represented “a start”, having tried to address his concerns over NHI’s ‘mandatory’ nature and the confidentiality of patient data, but were numerous gaps and questions remained.

The FNM’s Elizabeth candidate said, for instance, that the Bill was completely silent on catastrophic illnesses, referring only to the provision of primary care benefits and services.

This, he added, raised immediate concerns over how the Government’s proposed $25 million catastrophic healthcare fund would be governed and operated under NHI.

Dr Sands warned that the seeming absence of any legislative regime governing this fund opened it to potential abuse, and accusations that some patients were receiving preferential treatment.

“The fact it’s [the Bill] only speaking to primary care raises the question of how the Government intends to use the funds they’ve set aside for catastrophic care,” Dr Sands told Tribune Business.

“It does not speak to catastrophic care. If you go through the entire Bill, you will not find any reference to catastrophic care.

“It raises the question of how will that money be spent, and what checks and balances will be put in place to avoid any misuse - or perceived misuse - of catastrophic funds.”

Similarly, in the absence of any rules, Dr Sands questioned how one patient would qualify for assistance from the NHI catastrophic fund while another did not.

“You’re setting up for inappropriate largesse and patronage in the absence of legal guidelines from that catastrophic fund,” he told Tribune Business. “It will only lead to abuse.”

Dr Sands added that the Bill’s Section 31, which allows for the termination of healthcare providers’ NHI contracts over offences such as submitting a fraudulent claim or breaching patient confidentiality, “seems somewhat draconian”.

Explaining that this could result in a doctor being unable to practice in the Bahamas, he added of Section 31: “I laud the principal, but these things need to be fleshed out more - how someone has violated the provisions, what is fraud....”

Tribune Business reported on Friday how the revised NHI Bill eliminates the mandatory legal requirement for all Bahamians and legal residents to sign up for the scheme, while also tightening patient data safeguards.

Both had been key concerns for Dr Sands, who responded: “I don’t know if I can take credit for it, but they either listened to someone or it was obvious that, upon review, the legislation needed substantial revision.”

This newspaper also revealed that notably absent from the draft legislation release were the accompanying regulations and any details about NHI’s costs - how much it will cost in total, who will finance it, and how much they will have to pay.

The regulations typically give all Bahamian legislation their ‘enforcement teeth’, and contain the ‘devil in the detail’ in terms of how it will operate and be implemented in practice.

Their absence leaves significant unknowns regarding NHI, especially as the regulations will specify the “contribution rates” that Bahamians and their employers will pay to finance the scheme.

“The devil is in the details, and there’s not a whole heck of a lot to delve down into to understand what’s coming,” Dr Sands acknowledged.

“This seems to be the overarching legal framework, but the details to make this a living, breathing document are absent.

“The most I can say is that it’s a reasonable start, but there’s a hell of a lot more work that needs incorporating into this to bring it to life. There’s more to go, and this is what happens when you rush it.”

Dr Sands added that the Bill failed to reflect the healthcare industry’s practical realities, in that was trying to define the separate roles of primary care physicians and specialists.

“That is not the way things work in the Bahamas,” he told Tribune Business. “There are many physicians that provide primary care services, and this Act does not speak to that.

“It says that if you’re desirous, you can apply and, if on the schedule, you can enrol patients. There’s not enough flexibility built into this Act to cover the realities of practicing medicine.

“If this Act is intended to change the methodology of the delivery of healthcare in the Bahamas, it is not substantive enough - on a first and second reading of the Bill - to do that.”

Similarly, Dr Sands said the $10,000 fine for breaching patient data confidentiality “doesn’t go far enough”.

“You can do a lot of damage to an individual with the disclosure of information and, to me, even if you put in a potential term of 10 years’ imprisonment, I don’t think it goes far enough.”

Dr Sands said the NHI Bill also failed to detail any appeals process, whereby patients, doctors and insurance companies could challenge decisions by the NHI Authority.

He also criticised the March 2 deadline for healthcare industry stakeholders to submit feedback on the proposed Bill - a timeline that allows just 13 days for a response.

“Are you serious?” queried Dr Sands. “Clearly, they’re not interested in a response. What they want to say is they invited a response.”