The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A Canadian healthcare expert yesterday predicted that Bahamian doctors will drop their opposition to National Health Insurance’s (NHI) preferred payment mechanism “within three years”.

Dr David Price, who is advising the Government’s NHI Secretariat and consultants, KPMG, on the scheme’s roll-out, said the capitation mechanism was being designed with “a pretty good cushion” that would prevent physicians from suffering financial losses.

He told Tribune Business in an exclusive interview that the capitation rates were being based on doctors receiving 2.2-2.3 visits from each patient per year, which was more than three times’ the Bahamas’ 0.7 annual visits average.

Capitation, which would pay doctors a set fee per patient, per year, is NHI’s preferred mechanism for compensating physicians. However, many doctors in the private sector are opposed to it, having previously told Tribune Business that their remuneration would be cut by up to 70 per cent.

Dr Price and KPMG executives argued, though, that capitation had numerous merits, as it provided doctors with a predictable, set income upon which they could base their business and investment decisions.

They added that it would also “incentivise” doctors to keep their patients healthy and engage in preventative medicine, resulting in better treatment outcomes and greater patient satisfaction.

NHI’s current design attempts to accommodate physician concerns, as it gives them the choice of capitation, fees-for-services or a hybrid of the two as their preferred remuneration method.

However, Dr Price, chair of the Department of Family Medicine at Canada’s McMaster University, expressed confidence that private Bahamian physicians would switch to capitation once they became familiar with the system and its benefits.

Suggesting that the Bahamas would likely “parallel” the experience of Canada’s Ontario province, he told Tribune Business: “I would predict that within three years almost nobody will be left on fees-for-services.

“Physicians will migrate to the capitation model. They will be more satisfied in their own work, will be seeing better outcomes from patients, and patients will like the model, too. It’s kind of that virtuous cycle.”

Simon Townend, the KPMG (Bahamas) partner and head of the firm’s Caribbean advisory practice, added of capitation: “It’s good for the Government, good for the provider and good for the patient.” To which Dr Price added: “It’s good for the system. It’s that quadruple effect. Because doctors work more collaboratively, you have better outcomes.”

Capitation rates will also be risk-adjusted according to a patient’s age, gender and where they live (Family Islands versus Nassau), so that doctor compensation is linked to the health of their patient population.

“The hope is that they’ll see the benefits become more apparent and choose to quickly migrate to a capitation model,” Adrian Hamilton, a management consultant director with KPMG Advisory, told Tribune Business.

Whether private Bahamian physicians agree remains to be seen, given the opposition to capitation as a payment mechanism.

However, Dr Price said the system was being designed to guard against doctors suffering losses through receiving insufficient capitation compensation via the NHI scheme.

“In the Bahamas, the number of visits is 0.7 visits per patient per year,” Dr Price told Tribune Business. “In Ontario, it’s two visits per patient, per year.

“The modelling here [for NHI] is at two visits per year; slightly more than that. You’re looking overall at 2.2-2.3 visits per year, which is higher utilisation than in most jurisdictions. To me, there’s a pretty good cushion in this model that has been developed.”

Many doctors, though, believe that the 2.2-2.3 visits per year estimate is too low, given the high level of non-communicable diseases (NCDs) in the Bahamas and the health problems prevalent among large sections of the population.

When NHI is implemented, they fear Bahamians will swamp the healthcare system in the belief that they can now take advantage of free healthcare, dramatically increasing the number of annual patient visits.

Dr Price, though, said Canada’s switch to a capitation model 20 years ago helped to solve problems associated with the lack of medical services in remote areas.

Suggesting there were parallels with the Bahamian Family Islands, he added: “By putting in a capitation model that was structured for age, gender and geography, physicians and allied professionals were willing to go to remote areas, as they had guaranteed income and were able to invest.”

An ‘NHI Road Map’ report obtained by Tribune Business sets out the Bahamas’ health problems in graphic detail, noting that Bahamians “live five years less on average” than many other countries.

Avoidable mortality accounts for 700 deaths every year, and the report added: “According to WHO, the Bahamas has the highest percentage of NCD deaths for males under the age of 70 (60.3 per cent of all male NCD deaths), and a very high rate for females (47.5 per cent of all female NCD deaths, fifth of the 35 countries.”

The Bahamas was also branded the world’s “sixth most overweight country”, with the “highest prevalence of diabetes” on the planet.