The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

National Health Insurance (NHI) “is simply impossible” without the Bahamian medical profession’s support, a well-known physician warned yesterday, with the Government facing a growing, profession-wide rebellion against the scheme.

Dr Duane Sands told Tribune Business that NHI “cannot happen” even if the Christie administration makes good on hints it will bring in foreign doctors, adding that these could be imported from “Timbuktu or wherever”.

He was speaking after multiple medical associations representing Bahamian doctors yesterday came together to demonstrate their unified opposition to NHI, and to support the Consultant Physician Staff Association (CPSA) for the public stance it took on Sunday,

The doctors are arguing that the Government has ignored their views and input into NHI’s design, even though they are the front-line professionals responsible for patient care.

They believe that NHI as structured fails to address the existing weaknesses in the public healthcare system, a position that was fully backed by the Bahamas Doctors Union (BDU).

The BDU, which represents junior doctors, and with most of its members drawn from the public sector, said it was unable to “fully endorse the proposed plan” due to the lack of NHI specifics provided by the Government.

Reiterating a familiar theme, namely that the union and its members had not been allowed to properly participate in NHI’s development and design, the BDU acknowledged it was “in a most precarious position” given that it was criticising an initiative by the employer for most of its members - the Government.

The doctors’ union listed 10 concerns over the proposed NHI scheme, including the “cadre of inefficiencies” and financial waste that already exist in the public healthcare system, plus “low morale” among doctors and other healthcare workers employed by the Government.

“There are currently a cadre of inefficiencies that must be addressed in the public care system [before NHI],” the BDU warned, “primarily the wastage of 25 per cent of financial resources as pointed out by Dr Glen Beneby, chief medical officer of the Ministry of Health, which suggests ineffectiveness in the system that should be addressed before moving forward.”

The BDU said there were also insufficient staff numbers to cope with the increased demand for healthcare services that NHI will create, blaming this on “the hurried manner of implementation, which proposes inappropriate planning and poor consultation with health care workers despite their willingness to participate”.

And the BDU further warned: “The absence of job security for Bahamian doctors in the public sector has created a stressful, uncomfortable and exploitative environment for junior physicians.

“The morale is low among most health care workers, especially doctors in the public health care system that have given unconditionally to the profession in pursuit of the highest level of patient care.

“Despite the dedication and sacrifice shown by medical doctors, they remain marginalised in the management/administration of health, have been overlooked financially, and have to cope in many cases with undesirable working conditions. The disenfranchisement of junior doctors has created a rift in the system that requires immediate remedy.”

The BDU added that patient education on NHI was lacking, and argued that the scheme - whose total cost is still unknown - represented a threat to Bahamian economic stability due to the additional tax burden it ultimately threatens to impose on workers and employers.

“The tax burden being proposed for the Bahamian public is concerning, considering the current economic state of the country,” the doctors’ union said.

“With this in mind, the sustainability of the programme is placed in jeopardy. The repercussions of a failed programme will be far-reaching, and possibly catastrophic, for the healthcare system and the vulnerable Bahamian citizens.”

Prime Minister Perry Christie has previously said a tax to finance NHI will only be introduced when the Vital Benefits Package, its basic level of care, is rolled out.

While there have been suggestions that this might occur by year-end, the Government is unlikely to risk imposing yet another tax on Bahamian voters just prior to a general election. A 3 per cent payroll tax, split 50/50 between employer and employee, is understood to have been recommended as the initial NHI funding mechanism.

Dr Sands said the organisations present at yesterday’s press conference represented several hundred Bahamian doctors, which should send a message to the Government regarding the growing opposition to NHI.

“I think the position of the physicians as a group of stakeholders is fairly clear in that while we support the principal of universal healthcare (UHC) and the tool of NHI, the process has been less than ideal, the plan for implementation is not the right one, and there is much work to be done,” Dr Sands said.

The newly-approved FNM candidate for Elizabeth, when asked by Tribune Business whether NHI could be implemented without the medical profession’s support, answered emphatically: “No.

“Despite the confrontational and most unfortunate language of the minister with responsibility for National Insurance, it is simply not possible,” Dr Sands told this newspaper.

“The Government can threaten to bring physicians in from Timbuktu and wherever; it cannot happen.”

The medical profession is increasingly speaking with one voice on NHI, which is likely adding to the growing pressure on the Christie administration as it rushes to implement its healthcare reform.

With the CPSA now backed by the BDU and other associations, the Government has yet to see one doctor register as a provider under NHI. Unless enough doctors sign on to offer services under the scheme, it will be extraordinarily difficult for the Christie administration to get the scheme off the ground.

While the doctors thus have significant leverage over the Government where NHI is concerned, Dr Sands hinted that the profession also needed to strike a conciliatory tone and see if a “compromise” could be reached with the Government.

“Now is the time for some real work to be done, and concessions and compromises to be made,” Dr Sands said.

“I hope there’ll be a cooling-off period for a day or two and then, hopefully, if this administration works assiduously on behalf of the Bahamian people, as they say they do, we can come up with something we are proud of as a people.”

Calling on the Government to realise it was not the only party with a stake in NHI’s success, Dr Sands added: “When you are forced to take an adversarial stance on something that is an affront to your ethos and professional standing, it’s not something you are proud of.

“The Government has put the medical profession in a position where we have to take a stand on principle... The fact doctors felt prepared to take such a strong stand shows it’s a principled position. It’s a principled position that says we can do better now.”

The BDU urged that NHI be implemented slowly over five to 10 years, and it called for better job security and compensation of Bahamian doctors.

“This would inhibit the decline in the field, improve deteriorating enthusiasm, promote a better working relationship and discourage the impending exodus of competent Bahamian doctors,” the BDU said.

The doctors’ union also backed the removal of taxes on the healthcare industry, and called for greater investment in technology - especially electronic patient records.