The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Doctors yesterday said it was impossible to determine whether National Health Insurance’s (NHI) $100 million budget will be sufficient to cover all the medical services proposed for its primary care phase, as payment rates and provider numbers remain unknown.

Dr Sy Pierre, the Medical Association of the Bahamas (MAB) president, told Tribune Business that the main issue with NHI remained “the quality of care” and patient treatment outcomes under the new system,.

Speaking after the NHI secretariat this week unveiled the scheme’s draft benefits package, Dr Pierre said it was impossible to tell whether the $100 million budget would be sufficient to finance all the Government is promising.

“I don’t know,” he told Tribune Business, suggesting it was impossible to determine this without knowing how many Bahamian doctors had signed up to provide NHI services, and the compensation rates the Government will pay them.

There are indications that the pace of doctor sign-up is not meeting the Government’s expectations, as the NHI project manager this week seemed to appeal for the Bahamian public to pressure physicians into providing services under the scheme.

“The success of NHI Bahamas is dependent on the support of Bahamians and physicians,” Dr Brennen was quoted as saying in an NHI secretariat release.

“While we continue to receive positive support from the physician community, Bahamians should encourage their doctors to register for NHI so they can select their preferred provider during enrolment.”

Dr Pierre said the Government appeared to be basing the NHI budget on estimates for utilisation rates, meaning how frequently Bahamians will visit their doctor for medical treatment.

“They’re doing it under the guise of having ‘x’ amount of healthy people and ‘x’ amount of sick people,” the MAB chief suggested. “We have to see who signs up, and what the remuneration rates are; how much they’re going to pay. Who’s going to work with what they’re proposing?”

Dr Pierre added that NHI’s evolution over the next several years would have to be observed to see if it resulted in long queues and waits for treatment, as has occurred with similar healthcare schemes elsewhere in the world.

“The question has always been the quality of care: That has always been the question,” he added.

The NHI secretariat earlier this week unveiled a comprehensive draft primary care benefits package, covering medical services that include mental healthcare, diabetes and hypertension, high blood pressure and cholesterol, and cancer through to annual physicals and regular check-ups.

Dr Pierre, though, suggested that the benefits offered were little different from what was currently available at Princess Margaret Hospital.

He said that only the delivery mechanism had changed, with private physicians sought out as NHI providers in a bid to take the burden off the public sector.

One doctor, speaking on condition of anonymity, said there was “no way in hell” that NHI’s $100 million would suffice to cover the primary care benefits being offered.

“They’re relying on the fact that the average Bahamian is not going to show up, and that’s a very bad assumption,” the doctor said. “If the average Bahamian does show up, and I believe they will, there’s no way in hell they can cover that.”

The doctor added that NHI’s demands would require them to take on extra staff “exactly at the same time they’re asking doctors to take a pay cut”.

“They’ll burn out $100 million, burn out the doctors and not get the quality of care and the treatment outcomes they expect,” the doctor told Tribune Business.

Dr Duane Sands, the FNM’s candidate for Elizabeth, told Tribune Business last night: “With so many variables it’s impossible to peg this thing.

“It [NHI primary care] could be as low as $10 million or as high as $200 million. How many people are there, how many visits will there be, what are the remuneration rates, how many people have signed up?” he asked.

“These numbers determine if this [$100 million] is an absolute shot in the dark or if there’s some scientific validity to this project.”

Dr Sands said the primary care phase’s cost estimate could be akin to seeking to buy one thousand gallons of gas at $1.50 per gallon, a price that was impossible to obtain in the Bahamas.

“Where’s the meat and when are you likely to produce the meat?” Dr Sands asked of NHI. “Flesh it out. Let’s see what’s expected, and what is likely to be delivered and can be delivered.”