The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Medical Association of the Bahamas (MAB) president says it is "inexplicable" that the Government is planning to expand National Health Insurance (NHI) at a time when it claims 'the cupboard is bare'.

Dr Sy Pierre, in a statement to Tribune Business, said it was vital that the Minnis administration determine how NHI "can best provide value for the Bahamian people" - especially if the scheme is ultimately financed by taxation.

Confirming that the MAB's executive council had met with Dr Duane Sands, minister of health, to discuss the scheme, Dr Pierre said that while the new government was trying to move NHI in the right direction it was not there yet.

He added that the model left by the former Christie administration was not fiscally sustainable, and warned that if NHI was not handled correctly it "has the potential of becoming a veritable money pit that will thrust the Bahamas into even greater poverty".

Dr Pierre also contrasted the Government's criticisms of the NHI scheme while in Opposition with its plans to now expand it to secondary and tertiary care, despite the Bahamas' strained fiscal circumstances - which now include the threat of a second downgrade to 'junk' creditworthiness by Moody's.

"When in Opposition, the present Government bombarded the media constantly, pointing out the inadequacies of the proposed NHI programme - poorly planned, inadequately funded, ill-suited for our health care needs, etc," the MAB president wrote.

"Bahamians may be forgiven for believing that, once elected, the new Government would take steps to retrench and rethink its approach to health care. It seems inexplicable that now that they are no longer in the Opposition, members of this Government not only want to continue with an NHI-funded primary care programme but also expand the programme to include specialty care. This at a time when, by its own admission, 'the cupboard is bare'."

Dr Sands previously told Tribune Business that the Minnis administration had to identify funding for NHI, after the former government failed to sequester - or allocate - the $100 million for the scheme's primary care phase and $24 million for catastrophic care.

NHI's launch, prior to the general election, was being financed from the Consolidated Fund into which VAT and all other taxes are paid. Dr Sands subsequently said NHI's budget for the 2017-2018 fiscal year was being cut to $40 million, with $15 million each for primary and catastrophic care, and $10 million to finance the NHI Authority's creation.

This prompted Emmanuel Komolafe, the Bahamas Insurance Association's (BIA) chairman, to query how the Government planned to make NHI work with reduced funding and to brand the NHI Authority's needs as "quite excessive".

Dr Pierre, meanwhile, likened the former administration's NHI scheme to the Wendy's TV commercial where three elderly ladies are served a hamburger only to find a very small burger in the middle.

Implying that NHI had very little on the inside despite the glossy marketing, the MAB president said the key question was: 'Where's the beef?' or 'Where's the value?'

Emphasising that Bahamian physicians were committed to delivering quality healthcare, Dr Pierre wrote: "We welcome any fiscally sustainable plan that will achieve this, but the current plan does not meet that criteria.

"However, since the Government seems determined to move forward with an NHI scheme in some form - along with the inevitable increases in taxation that this will bring to bear - the important question to address is: How can NHI best provide value for the Bahamian people?"

Pointing out that virtually all Bahamians enjoyed access to healthcare pre-NHI, Dr Pierre said Bahamians had to acknowledge that "the NHI scheme in its present form provides absolutely nothing not presently available in the public health sector.

"Yes, it is true that our public healthcare system is beset by management issues, excessive red tape and misuse of resources. However, upwards of 90 per cent of the health care needs of Bahamians are accessible - right now - through the public healthcare system," he explained.

"The proposed NHI scheme will not add a single service, test, screening or care opportunity that is not presently available to the Bahamian public. So why add millions of dollars of additional debt, new layers of bureaucracy and opportunities for mismanagement for a service that presently exists?"

Dr Pierre said the notion that NHI could provide similar amenities to those offered by private health insurance had been "debunked" by global experiences.

As a result, he argued that NHI should be focused on providing medical supplies and services that patients have to pay for in the public healthcare system.

"NHI would fund such things as vascular grafts for patients on dialysis, comprehensive cancer care, pacemakers, pediatric heart surgery, extended care including rehabilitation for stroke victims, etc," Dr Pierre suggested.

"NHI for services not presently available in the public sector will enhance our healthcare service, fully utilise our present infrastructure, add minimal debt, remove the need for cookouts to fund medical care and would receive buy-in from all stakeholders, especially physicians."

He continued: "The value is in providing medical services that are urgently needed but not presently available. If we must move forward with this concept, let it be in a way that truly benefits Bahamians and adds value to our standard of living.

"Hopefully, this government will listen to and execute the plans of our exceptional professionals, and not go searching the globe for foreign consultants. Or worse, attempt to implement some ill-conceived, hare-brained scheme meant to gain political traction but instead causes incalculable suffering for the Bahamian people."