The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The $100 million budget for National Health Insurance’s (NHI) primary care phase “isn’t much money”, the Medical Association of the Bahamas (MAB) president says, as he warned the Government it must “compromise” with the private sector.

Dr Sy Pierre told Tribune Business in a recent interview that the Government’s primary care budget was relatively small when measured against the 350,000 Bahamians and legal residents it wants to enroll in NHI.

Taking just the 200,000 said by the Government to currently lack private health insurance, Dr Pierre said this translated into a per capita spend of just $500 per year - less than $50 per month.

He added that this paled in comparison with private health insurance costs, where premiums can reach around $1,000 per month, suggesting that the NHI primary care budget could be rapidly exhausted - especially if patient utilisation rates exceed projections.

“It’s interesting,” Dr Pierre told Tribune Business. “If you look at the numbers, they’re saying there are 200,000 people without private insurance, and they’re giving $100 million to primary care.

“If you look at that, that’s $500 per person, per year. That’s not a lot of money. That’s under $50 per month, per person. You can’t really get private insurance with that.”

Throw in the 100,000-plus Bahamians and residents with private health insurance, many of whom will likely receive primary care under NHI when their employers drop existing schemes, and the per capita spending allocation becomes even smaller.

Dr Pierre said the Government appeared to be hoping that private doctors, through signing up to be providers under NHI, would help to “remove some of the burden off the public system” and thus give it ‘breathing room’ to be strengthened.

However, Tribune Business understands that no private physicians have signed up to provide services yet, and with mid-January already reached, the Government is rapidly running out of time to implement NHI prior to the upcoming general election.

Dr Pierre warned the Government it would likely have to reach an accommodation with private primary care providers to encourage them to participate, especially on proposed remuneration rates that represent as much as a 70 per cent cut to existing compensation.

“If they want people to provide that service, there’s going to have to be some compromise on what they’re asking people to do, especially at that remuneration,” the MAB president told Tribune Business.

Dr Pierre added that there were “certain bureaucratic things they [the Government] need to get out the way”, citing previous difficulties with Tax Compliance Certificates (TCCs) that had taken him up to four months to obtain. This issue was subsequently resolved.

Meanwhile, Dr Duane Sands, the FNM’s candidate for Elizabeth, again argued that political imperative was likely to smother practical reality when it came to NHI, and whether it was ready to be rolled out.

“I think the narrative with this is damn the torpedoes, we’re going to push on,” Dr Sands told Tribune Business. “This is a hugely ambitious project, yet it is a critical part of the re-election strategy of this administration.

“So whether it’s ready, whether it’s good, no matter, we’re putting it out there. We’re going to start it and fix it later. They’re going to want a couple hundred thousand Bahamians to touch NHI, so they can say: ‘We promised this, and have delivered this’.”

Dr Sands then reeled off a litany of NHI ‘unknowns’, including the fact that private physicians have to-date not signed up to provide services under NHI. He pointed out that benefits packages have yet to be finalised; no decision had been communicated on whether the scheme will use branded or generic drugs; and training persons to deliver NHI had yet to occur.

Doctors, Dr Sands added, had also not been informed how they would bill for their services, to whom the bill would be sent, and the codes to be used.

“I think they are rapidly running out of time to do this thing even remotely realistically,” he told Tribune Business of the Government, “yet I have no doubt they are going to roll this thing out. They’re going to go with what they have.”

Tribune Business on Monday revealed the findings of the National Health Systems Strengthening Committee, which in September 2014 detailed numerous issues that “must be addressed” prior to implementing universal health coverage (UHC) and NHI in the Bahamas.

Its report called for Bahamian healthcare’s governance structure to be completely reformed, and overseen by a Bahamas Public Health Authority, through which the Ministry of Health will be responsible for standards, policies and regulation.

Underneath it will be the Public Health Authority, an amalgamation of the PHA and the Department of Public Health. And, finally, there will be four regional health authorities, each responsible for the northern, central, southeastern and southern Bahamas, respectively.

The Committee called for the Ministry of Health to be strengthened, noting: “While the Ministry of Health has oversight of various councils and boards, its current organisational structure and human resources (HR) capacity are inadequate to effectively execute the [NHI] steering role functions. The committee recommends building human resources capacities as well as a revision of Ministry of Health’s organisational structure.

“The committee has concluded that although legislative reform will be necessary, it would be best to adopt administrative mechanisms that improve the functioning of the Ministry of Health in the initial stages. Such an approach would ensure that legislative changes are driven by pragmatism and lessons learned from experience on the ground.

“These changes will diminish the fragmentation of government health services, provide greater autonomy and allow for seamless movement of clients across the care continuum (where the continuum of care is a concept that involves an integrated system of care that guides and follows an individual over time through a comprehensive range of health services across all levels and intensity of care).”