The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A well-known physician says he is now “even less confident” that National Health Insurance (NHI) will be able to protect taxpayers and patient confidentiality, while expressing concerns about the quality of care that will be offered.

Dr Duane Sands, the FNM’s candidate for Elizabeth, told Tribune Business that “the grade and calibre” of doctors that sign up as NHI providers is more important that the actual numbers.

A spokesman for the NHI Secretariat told Tribune Business on Friday that officials were “happy with the process so far”, although they provided no numbers on how many doctors had signed on since registration was launched on January 31.

“The NHI Secretariat has seen positive support from the physician community,” the spokesman said via e-mailed response to Tribune Business inquiries.

“These key partners appreciate and value the importance of one-on-one discussions and group information sessions that we have engaged with them to ensure all their questions are answered, and facilitate any additional support in the provider registration process.

“To further support the provider community, the NHI Secretariat has scheduled nearly a dozen group information sessions during the month of February and March.”

Dr Sands, though, said that given the Bahamas’ “astonishingly horrendous” healthcare issues, especially with chronic non-communicable diseases, it was vital that NHI put “the best team forward” in terms of doctor quality.

“We’ll see what happens, not only the numbers but the grade and calibre of physicians that sign up,” he told Tribune Business.

“The question is whether or not these individuals who have not yet been granted the right to practice in an unsupervised setting ought to be the mainstay of care for an expanded public healthcare system.

“It doesn’t make an awful lot of sense to me, taking nothing away from what they bring to the table.”

Dr Charles Clarke, head of the Bahamas Doctors Union (BDU), has frequently been wheeled out at NHI press conferences to suggest that the scheme - due now to be launched in May - has the backing of Bahamian physicians.

However, he and the BDU largely represent the junior doctors in the public healthcare system, and do not speak for private practitioners whose buy-in is vital if the Government is to both reduce the burden on its system and provide NHI enrollees with a high quality of care.

Dr Sands said NHI could not succeed without the likes of specialists in family medicine, internal medicine practitioners, paediatricians and obstetricians, as they were “the core, the front line that are appropriately equipped to deal with the surge facing the Bahamas”.

Given this nation’s healthcare statistics and indicators, he added: “You are going to need your best and brightest on the frontline if you’re going to have the highest impact.

“It’s already predicted that it will take the best part of a generation to see a reduction in morbidity and mortality from non-communicable diseases. If we don’t put our best team forward, it’s going to take two generations.

“The idea that you’re just going to put anybody out there to provide that type of care suggests simply that this is more about optics than care.”

Dr Sy Pierre, the Medical Association of the Bahamas (MAB) president, backed up Dr Sands’ concerns about the quality of physicians and subsequent care under NHI.

He confirmed that at a recent MAB meeting, where 30-40 doctors were present, not one admitted to signing up to provide services under NHI.

“No one admitted to signing up. Some people wanted a show of hands,” Dr Pierre said, confirming that the latter request did not happen.

“Obviously, the [NHI] remuneration is going to be very low, and people were saying they can’t run their office off of this. A senior consultant may not be able to, but a junior doctor or general practitioner may be able to.

“But if someone needs to feed their children and pay their school fees, they may be challenged. Some of the people with large practices are not going to sign up. But those who have to sign up will sign up.”

Another doctor, speaking to Tribune Business on condition of anonymity, added: “I don’t know a single person who has signed up to it. As of right now, no one knows a single person who’s done it. They didn’t get the response they were looking for at the meetings, and they’re not getting the response they expected in registration.

“There’s a tonne of doctors out there who have no clue. A lot of doctors have been pretty complacent about it because they don’t believe it’s going to happen.”

Dr Sands, meanwhile, reiterated long-held concerns that the absence of an NHI-wide information technology (IT) system, and electronic medical records system, left the proposed scheme wide-open to patient and provider fraud, and other forms of financial abuse.

“I had a conversation with one of the Cabinet ministers about this,” he told Tribune Business. “Certainly, I am even less confident given where they are with the IT platform in terms of protecting the public purse and confidentiality of data.”

Dr Sands said “nothing is in place” regarding an NHI IT system, even though talks may have taken place with potential vendors and suppliers, and a tender document developed.

He added that Doctors Hospital launched its electronic medical records system 10 years ago, via a phased approach that gradually extended it across all necessary professions.

“The roll out took the better part of four-five years,” Dr Sands said. “Even today, this system, more than 10 years old, we’re still finding glitches, and that is in a 70-bed hospital.”

Comparing this to NHI’s nationwide requirements, he added: “It is almost impossible that any timeline less than a few years is do-able. But they’re hell-bent on rolling this thing out.”