The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Bahamian public health system’s many flaws cannot be fixed “immediately”, the Government’s advisers conceded yesterday, as they expressed confidence that a “silent majority” of private doctors were willing to sign on for National Health Insurance (NHI).

Dr David Price, a Canadian healthcare expert who is assisting the NHI Secretariat and its advisers, KPMG, told Tribune Business that the problems should not be used to delay the Government’s reforms indefinitely.

“I don’t think you can fix those things immediately,” he said, after Tribune Business questioned whether NHI could succeed without first fixing the numerous structural weaknesses in the public system. “You have to have a plan and vision to get to the end point, and that’s what’s being developed here.”

Many healthcare industry professionals have argued that the Government’s plan to introduce universal health coverage (UHC) in the Bahamas, for which NHI is the financing mechanism, will be doomed to fail without the public system being strengthened.

Dr Kevin Bowe, the NHI secretariat’s deputy project manager, acknowledged to Tribune Business that much needed to be done in terms of improving the public healthcare system, but implied that it was no reason to delay NHI’s implementation.

“We know there’s a lot to be done in terms of those facilities, and quality of service in those facilities,” he conceded. “We have to address the public facilities; that’s clear.

“But we always say we can’t wait for everything to be in place to start this process. There’s a quality of life and anticipation of people for the interventions they need.”

Dr Price, a primary care specialist, told Tribune Business he had been “really impressed” with the quality of care he had witnessed at the South Beach clinic, despite “the overwhelming demand and resources they have”.

He added: “I was quite impressed in the ability of the folks there to provide care in those circumstances; that needs to be acknowledged.”

Dr Bowe argued that NHI provided the ideal opportunity to bridge “the divide” that existed between the public and private healthcare sectors, adding that “this is time for the left hand and right had” to work together.

“Is this doing something of value to our people? It is,” he added of NHI.

The Government’s NHI consultants yesterday made clear that the ‘buy in’ of private physicians, and their signing-up to provide services under the scheme, is critical to the $100 million primary care phase’s launch.

Without their participation it is unlikely to happen, as the private doctors are needed to take patients currently seen by the Government clinics and improve access to care, thus taking the burden off the public system and providing breathing space for its weaknesses to be addressed.

Private physician sources, speaking previously to Tribune Business on condition of anonymity, said no one was willing to sign on to provide services under the current NHI design.

They suggested that the only participants would be junior doctors in the public system, plus private practitioners who needed the extra patient volume.

The Government’s advisers, while not providing any figures for how many doctors were required to launch the primary care phase, said they were working to build “critical mass” to meet the anticipated patient demand.

And they denied that few private doctors were willing to sign up as NHI service providers, saying ‘exit surveys’ at consultation meetings showed that a majority of attendees “were willing” to participate.

Adrian Hamilton, a management consulting director with KPMG (Bahamas), told Tribune Business: “There’s a majority that said yes. I think there’s a silent majority that’s very keen and anxious to sign.”

With the enrolment of physician providers set to begin with the next several weeks, Dr Bowe added: “We’ve had people say: ‘Show me the dotted line and I’ll sign now.’ We’ve had to say: ‘Not yet’.

“People will choose to tell you what they want. We meet with physicians and they know what is being planned. Let’s start small and build up.”

The NHI primary care benefits package is “very, very, very close” to being finalised, Tribune Business was also told yesterday, with feedback from the healthcare industry having helped to “shape” its content.

Many, though, are likely to be dismayed - but not surprised - at its decision to forge ahead with NHI implementation and fix the public system’s weaknesses ‘as we go along’.

A 2014 report by the National Health Systems Strengthening Committee, which has never been widely-circulated or published, lists numerous issues that “must be addressed” prior to implementing universal health coverage (UHC) in the Bahamas.

It warned that the Bahamas’ existing healthcare model is one that has been shown to be “financially unsustainable” because it is focused on treating illnesses and disease, rather than on education and the promotion of healthy living and eating.

“The Bahamas, like its global counterparts, continues to grapple with health system performance,” the report admitted bluntly.

“Many of our existing challenges relate to deficits in the governance of system, services delivery and resource allocation (human and otherwise) that must be addressed to implement UHC in the Bahamas.”

Critiquing the existing Bahamian healthcare system, it added: “The current health care organisational model is characterised as being centralised, predominantly curative and disease-centred.

“However, the medical literature suggests that such systems are inefficient, offer relatively small gains, are spread unevenly across the population, and are financially unsustainable. In countries where the health system is orientated towards health promotion rather than a disease-based approach, governments have been more successful in creating health-promoting environments.”