The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The launch date for the National Health Insurance (NHI) scheme’s $100 million primary care phase has been pushed back to May 2017, Tribune Business can reveal.

The revelation came at a meeting last week of the Universal Health Coverage (UHC) Stakeholder Advisory Council, the body featuring both public and private sector healthcare representatives, which assists and provides feedback to the NHI Secretariat.

Notes of the meeting, which have been obtained by Tribune Business, disclose that the much-touted NHI launch has been pushed back to an undetermined date in May, which is around the time when the general election is likely to be called.

The NHI primary care phase was initially supposed to be launched in April 2016, but has since been postponed several times.

Dr Delon Brennen, the NHI project director, said earlier this year that the launch would now take place during the 2017 first quarter, but the notes from the Stakeholder Advisory Council meeting suggest it has now been pushed even further back.

“We know these timelines are totally unrealistic, but they’re going to press on and do something, whatever that something is,” one private doctor, speaking to Tribune Business on condition of anonymity, said yesterday.

NHI faces a key preliminary deadline/stage tomorrow, as this is when the enrolment of doctors who will provide services to the scheme is supposed to begin, together with the release of regulations that will govern how they operate.

The remaining NHI regulations, which will give the Government’s proposal ‘enforcement teeth’, are to be finalised by February 15, with the public health system’s clinics all “ready” by March 31.

The revelations come as the KPMG accounting firm, in a letter published on Page 3B in Tribune Business today, said it “stood firmly” behind its assessment that the Bahamian economy would be almost $500 million larger in 2040 as a result of implementing NHI’s primary care phase now.

Simon Townend, a KPMG (Bahamas) partner and head of its Caribbean and islands advisory practice, emphasised that its study was conducted independently of the Bahamian government - refuting charges it was ‘biased’ because of its role as the Government’s key NHI advisors.

Mr Townend said critics also “failed to appreciate” that economic impact studies typically took the long-term view, as he sought to rebut accusations that it had failed to account for the Bahamas’ current economic and fiscal conditions.

However, the Stakeholder Advisory Council meeting summary seen by Tribune Business suggests that much remains to be done if the NHI scheme is to operate at maximum efficiency and effectiveness, and benefit those Bahamians who need it the most.

It records a “disconnect” between the Ministry of Health and the NHI Secretariat that was threatening to undermine efforts to strengthen the public healthcare system - the very issue that has been identified as the scheme’s greatest weakness.

And the Government’s $18 million electronic medical records system, unveiled with much fanfare in recent weeks, “will not be functional prior to the proposed roll-out date”.

Details regarding a temporary Information Technology (IT) system, which the Government had promised would be put in place in time for NHI’s launch, were “unknown’.

And the Attorney General’s Office was said to still be reviewing the draft tender document for NHI’s main system provider, meaning that with three-four months left before launch, virtually nothing has been decided on the IT front.

One doctor, speaking to Tribune Business on condition of anonymity, warned that the absence of a nationwide NHI IT system left the scheme “wide open to fraud” by both physician providers, patients, insurers and others.

“This goes right back to transparency and accountability if they’re not going to have a medical healthcare records system,” the doctor said.

“How are they going to monitor the quality of care, determine the outcomes and oversee the physicians being given $20,000 a month to look after they’re population?

“They have no way to monitor activity because they have no electronic records system in place. The door is being left wide open to fraud. How are they going to keep people accountable without an accurate data system? You could put anything down. Who’s going to the auditing?”

Pointing out that all Bahamians and residents already enjoyed access to healthcare via the public clinics and hospital, the doctor said the real issue was “putting in standards of care, so we get a better quality of care.

“If there are poor outcomes under NHI, who’s going to be held accountable for them,” the doctor asked. “We see them every single day, as do most practices. There’s no mechanism for responsibility and accountability. If a physician’s not performing up to standard, who’s going to tell?”

The Stakeholder Advisory Council notes seen by Tribune Business refer to the creation of a Bahamas Health Authority via the merger of the Public Hospitals Authority and Department of Public Health, with legislation to give effect to this having been drafted.

The Cabinet has also appointed the Minister who will be responsible for NHI, and the members of the NHI Authority Board, although the names have not been released yet. There have been suggestions that Prime Minister Perry Christie may take on the ministerial role himself.