The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

THE board of the National Health Insurance Authority will consider introducing a co-payment system for primary healthcare, pharmaceutical and diagnostic services under NHI, Health Minister Dr Duane Sands revealed yesterday as he warned: “Nothing in life is free”.

If a co-payment system is introduced, it would be a blow to Bahamians expecting free service at the point of care as had been advertised for years by the Christie administration. Free healthcare at point of service was to be the defining quality of NHI.

Dr Sands also revealed that the Minnis administration continues to uncover new bills. When he spoke to The Tribune yesterday, Dr Sands said bills were sent to the government from KMPG seeking payments for NHI services for the months of April and May worth $543,000 and $338,000 respectively. This is on top of the $8.3 million he previously said was paid out to KMPG for its NHI consultancy services. Dr Sands said KMPG remains a government consultant but the scope of its work has been significantly reduced.

He also said the NHIA board will have to review the contracts for healthcare providers that were negotiated when they registered for the scheme prior to the board’s appointment.

“Those contracts are going to be reviewed and adjusted, renegotiated,” he said.

More than 60 providers registered for the scheme, the NHI Secretariat announced in April. The secretariat has also said laboratory services could now be received from at least five labs at no cost at the point of care.

The changes to the plan may happen because the former administration, which pledged about $125 million for the first phase of NHI, sequestered no money for this in the budget for this fiscal year, Dr Sands said.

Dr Michael Darville, former Minister for Grand Bahama, claimed yesterday that the Christie administration would have secured the necessary funding had it been re-elected. The Minnis administration has allocated $40m for the NHIA for this fiscal year. Of this, Dr Sands has said $15m will go toward catastrophic services, $15m to primary healthcare and $10m to the administrative infrastructure of the NHIA.

“Yes they will have to consider introducing a co-payment plan,” Dr Sands said as the NHIA board is expected to be appointed today. “NHI benefits package came complete with expectations that were heightened by public relations exercises and discussions for years in the lead-up to the rollout. People want what they believe they were told they were going to get and there were expectations of a comprehensive package. If there had been money available for those benefits we wouldn’t be having much of a conversation, but the truth of the matter is expectations were raised and the funds/revenue were never identified to pay for NHI.”

He added: “The board and the executive of the new NHIA will look at co-pays and subsidised rates for services. For example, a service may cost $100 in the private sector. We may try to negotiate a price of $50 and then have the NHIA, given the volume, agree to pay $40 of that and the patient pay $10. That’s just an example. The idea is that people can still get a $100 service that you pay $10 out of pocket for. But it’s not free. Nothing in life is free.”

Criticism

Such a system could amplify criticism that NHI is hardly different from what is already available to Bahamians at public clinics and at the Princess Margaret Hospital (PMH).

“You put cash at point of service and that defeats the purpose of NHI,” Dr Darville told The Tribune.

No matter what, Dr Sands said, NHI is not being halted.

“It is a peculiar scenario right now that NHI continues to be provided through the existing governance framework but in terms of payments for NHI, in this new dispensation beginning July 1 there is a requirement for the establishment of the NHIA, the appointment of the board and the managing director,” Dr Sands said.

“Services will not be halted. What has never been introduced in the NHI are the pharmacy services and some of the diagnostic procedures.”

The new board will review the advice and consultations given to the Christie administration and will adapt its plan to meet the country’s needs and budgetary constraints, Dr Sands said.

Regulations for NHI have never been released, but Dr Sands said he has given the new board “serious marching orders” and he does not expect that it will take long for the board to start making important decisions.

“I believe we have selected an excellent board,” he said. “When names are revealed Bahamians will see a group of Bahamians to serve that are actually an interesting and talented cross-section of society.”

The NHIA has functioned in recent months without a board.

Dr Delon Brennan, the project manager at the NHI Secretariat, is expected to become the managing director of the authority.

The lack of a formal management structure for the NHIA raised questions about the status of the contracts the NHIA executed with healthcare providers.

“The board will be in place by (Wednesday) and they’d have the ability to ratify retroactively what has been done,” Dr Sands said, adding that the board will review those contracts.

Dr Sy Pierre, president of the Medical Association of the Bahamas (MAB), said yesterday that he has received complaints from several clinics who signed up physicians as providers under NHI only to recognise that “it doesn’t make a difference now because we’re starting over from the beginning.”