The Tribune

By KHRISNA VIRGIL

Deputy Chief Reporter

kvirgil@tribunemedia.net

A DAY after it was revealed the National Health Insurance Authority Board will consider introducing a co-payment system for primary healthcare, former Grand Bahama Minister Dr Michael Darville railed against the move saying it was bound to remove the equity for Bahamians from the system.

Senator Darville told The Tribune no cash at the point of sale is arguably one of the most attractive features of NHI and to remove it would be a deterrent to the unemployed and indigent.

He defended the Christie administration's decision to implement a cash-free system for primary care and said this was done with a view to the long-term benefits of enabling early detection of chronic diseases.

Dr Darville also criticised the Minnis administration's $40m NHI budget. He said it was insufficient when compared to the $125m to $130m the former government intended to pump into the healthcare scheme.

However, when he was asked how the former government intended to gather this hefty sum, Dr Darville could not give a definite answer, but instead said: "We were going to find a way to fund it."

This comes after Health Minister Dr Duane Sands said on Tuesday the NHIA will consider introducing a co-payment system for the first phase of NHI to cover pharmaceutical and diagnostic services. In this regard, Dr Sands warned: "Nothing in life is free."

"First of all, based on evidence from (the) Pan American Health Organisation, in order to maintain equity in the system, we felt that for those who need healthcare the most (or) for those who cannot afford healthcare, if you put a co-payment for primary healthcare you actually take equity out of the system, meaning only those with money can access the system," Dr Darville said.

"We went against the recommendation of the World Health Organisation (WHO) as well as what is happening around the world elsewhere. We believe a service such as primary healthcare should be no cash at point of service in order to ensure that equity of those who are unemployed (and) those who don't have access to resources are not deterred from accessing primary healthcare services because of funding.

"What that does is, it saves the country a lot of money down the road because we could pick up diseases earlier. It means that we can protect individuals from going into the chronic nature because as you know chronic communicable diseases is what's really eating up the health care budget."

He continued: "So we, based on the advice of KPMG our consultant as well as PAHO, (decided) universal primary healthcare should be with no cash at point of service.

"Now when you start going into catastrophic care or the full medical package then you can take into consideration co-pay. So we were operating based on the advice that we received from our consultants as well as what's happening around the world that copayment for primary healthcare would definitely not create equity.

"So this whole thing about copay it goes contrary to the whole spirit of NHI."

Dr Darville also believes the government is not serious about universal healthcare.

"Well it's obvious, the $40m budget is not enough because the Christie administration based on the advice that was given to us, in order to run a relatively decent universal primary healthcare extending from Inagua into Grand Cay, the cost was estimated at $100m and we put an additional $25m to $30m for catastrophic care.

"This business with catastrophic care is the more people that access the primary healthcare network, the more we can pick up more advanced diseases.

This means you have to have a mechanism in place to treat those advanced diseases to prevent frustration. So we have to find some money to deal with the catastrophic illnesses that we'll pick up because now many more people will access the primary care.

"As far as the money is concerned, I believe that if the government was truly serious about perusing aggressively universal healthcare and some form of catastrophic care, their budget would have reflected that."

More than 60 providers registered for the scheme, the NHI Secretariat announced in April. The secretariat has also said laboratory services are accessible 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 $125m for the first phase of NHI, sequestered no money for this in the budget for this fiscal year, Dr Sands told The Tribune on Tuesday.