The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Doctors have had to wait up to six months to receive payment for treating public sector patients due to delays in obtaining Tax Compliance Certificates (TCCs), the Medical Association of the Bahamas (MAB) president revealed yesterday.

Dr Sy Pierre told Tribune Business that the payment woes were exacerbating his members’ concerns over the proposed National Health Insurance (NHI) scheme, especially given that the latter’s information technology (IT) system has yet to be sourced and implemented.

The MAB president said it was vital that NHI’s IT infrastructure be properly integrated with the National Insurance Board (NIB) and Department of Inland Revenue, otherwise physicians would likely experience the same TCC-related payment problems with the Government’s new healthcare scheme.

“We’ve had incidents of three to six months with physicians not being paid for providing services to public patients,” Dr Pierre told Tribune Business.

“Inland Revenue, they have been responsive, but it takes a while. I see the problems coming in on integration. NIB will say you are behind on paying contributions, or they can’t find your form, and will not make payments.

“The integration is going to be a big issue. There has to be integration between the NHI Secretariat, NIB and Inland Revenue. They all have to be on the same page. If this thing is not in place, it throws everything off.”

Given that the Government confirmed in late September 2016 that “the full [IT] system will not be in place for the launch of NHI”, it seems that the concerns of Dr Pierre and the MAB are justified.

Tribune Business previously revealed the private sector’s consternation with government requirements that they produce valid TCCs to obtain payment for goods and services ALREADY supplied.

The Government views TCCs as closing the tax enforcement circle, and eliminating compliance gaps and loopholes, but for Bahamian businesses they have only increased the stranglehold imposed by bureaucracy and red tape.

Companies with public sector contracts worth $10,000 or more must obtain TCCs on a monthly basis to prove they are in full compliance with are Business Licences and real property taxes, Immigration (work permit) fees, all Customs-related taxes, Value-Added Tax (VAT), NIB contributions and motor vehicle licensing fees.

Many have complained of encountering frequent delays in both obtaining TCCs and the necessary supporting documentation, and having to deal with multiple government agencies.

In turn, the TCC-related payment delays impact business cash flow and profitability, with Dr Pierre confirming that private physicians who treated public sector (NIB) patients were encountering the same difficulties as the rest of the business community.

One Bahamian doctor, speaking on condition of anonymity, told Tribune Business that the TCC issues were a major factor dissuading him from taking NIB patients.

Describing the situation as “absolutely insane”, the doctor described the predicament of a Family Island pharmacist who NIB stopped paying due to the absence of a valid TCC certificate.

“They want it from him every month,” they said of the pharmacist’s TCC. “But his old application was still in the system, so they could not put the new one in.

“It took two weeks to take the old one out, so that they new one could be entered, and in the meantime they stopped paying him.

“If he got cut off, how many others got cut off? It’s not just the doctors; it’s the pharmacists, too. It’s not that they haven’t complied; it’s just that they can’t get a TCC from the Ministry of Finance on time,” the doctor continued.

“It’s insane. This TCC thing is absolutely insane. I refuse to take NIB patients.

Despite the payment woes, Dr Pierre said doctors were not refusing to treat public sector patients, given that “often-times” they were being asked to deal with serious injuries.

“All of us are willing to take a haircut, and provide private care for public patients,” the MAB chief said. “We’ve been doing it for years.”

He emphasised, though, that the TCC-related payment delays not only impacted the doctors themselves, but also the likes of nurses and technicians they employed.

The Bahamas Chamber of Commerce and Employers Confederation (BCCEC) has been lobbying the Government to extend the validity of TCC certificates from one month to three months, so that the level of bureaucracy and private sector stress is reduced.

Meanwhile, Dr Pierre told Tribune Business he would be “surprised” if NHI was ready for launch in early 2017, saying a mid to late-year target was more reasonable given the key issues that remain unresolved.

“We have quite a few concerns, some of which have been addressed,” he said. While all healthcare industry stakeholders are represented on the Universal Healthcare Advisory Council, and were being allowed input into the NHI process, Dr Pierre said this did not mean the Government was adopting their advice.

“We can have input, but nothing we say they have to follow,” the MAB president added.

While the Government has been consulting the physician community on the proposed NHI primary care benefits package, with feedback due in by yesterday, Dr Pierre said: “Nothing is set in stone.”

Without the participation of private primary care doctors NHI is doomed to fail, yet none have yet signed up to take patients - something that is vital if the existing burden on the public health system is to be eased.

Financial remuneration agreements with doctors and laboratory technicians have yet to be worked out and finalised either.

And Dr Pierre also pointed out that the IT network necessary for registering patients, and establishing electronic healthcare records for every NHI member, had yet to be implemented.

“This will be impossible without electronic health records,” he added, explaining that it was vital to monitor the progress of patients sent for laboratory testing, or transferred from the Family Islands to Nassau.

Asked to define a feasible timetable for NHI’s primary care phase launch, Dr Pierre told Tribune Business: “I would guess mid to late year 2017.

“It would be nice if it was early, but I don’t see how if the IT process is not in place. It will be very difficult to see patients and have them go to the laboratory. If it happened by January/February, I’d be pleasantly surprised.”

He added: “It’s a massive project, but the Bahamas has less people than IBM has employees. It’s not like you’re dealing with millions of people.

“If you have sufficient staff and resources, it can be pushed forward if the political will is there. We’re not a huge country.

“The NHI Secretariat have been working on it for a while. It’s doable, but it’s going to require a lot of work. The ball is in their court.”