The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Medical Association of the Bahamas (MAB) president says he “can’t understand” why the Government is so reluctant to “scrap” the National Health Insurance (NHI) scheme and go back to the drawing board.

Dr Sy Pierre told Tribune Business that the Minnis administration seemed to be persisting with efforts to “stick a square peg in a round hole”, despite its criticisms of NHI as currently structured when in Opposition.

Warning that the Government was in danger of “throwing good money after bad”, the MAB chief said the Minister of Health’s confirmation that the scheme is presently wide-open to fraud and other financial abuses was “very concerning”.

“I can’t understand why they cannot listen to the professional people; the doctors, insurers and others, and scrap the system, let it go,” Dr Pierre told Tribune Business.

“It makes no sense. It’s absolutely crazy. I have already had this discussion with him [Dr Duane Sands, minister of health]. They seem to be soldiering on with the system, even though they said it was a mess before.

“They seem to like wanting to stick a square peg in a round hole,” the MAB chief continued. “Continuing to throw good money after bad is not going to make the situation any better.

“For some reason, they’re trying to fight human nature, almost. By their votes, the Bahamian people expressed how bad things are, that they’re willing to tighten their belts and go through pain to get out of this [fiscal and economic situation’.

“If they came to the people and said ‘We can’t do it’, but will get the system together and provide a catastrophic care plan, I don’t think anyone would have a problem with that.”

Dr Pierre questioned what NHI would give Bahamians that they were not already receiving, given that all citizens and legal residents currently enjoy access to healthcare via the public sector.

“If we’re going to have NHI, let’s have it for something we don’t have, such as a catastrophic care programme,” he added.

Questioning why the Bahamas was forging ahead with another expensive social initiative, despite being confronted with a second ‘junk’ downgrade, Dr Pierre said NHI-style financing schemes had produced unintended consequences whenever they were implemented.

He argued that they often became an unsustainable financial drain on a government’s finances, or resulted in reduced quality of care, waiting times and the rationing of treatments.

“NHI has never worked anywhere else on a large scale,” Dr Pierre told Tribune Business. “It’s economic absolutes. If you cap the cost of care, you will have increased demand and a reduced supply of physicians.”

He said the MAB and its members had warned the former Christie administration that NHI was exposed to fraud and other forms of corruption without the necessary “checks and balances”, especially a comprehensive, scheme-wide IT system.

Without this, and the scheme’s regulated health administrators (RHAs), being in place, the MAB chief confirmed that it was impossible to verify the accuracy of medical bills submitted by participating doctors.

He added that it was also possible for two doctors to treat the same patient, and even submit billings for treatments never rendered or medications that were not prescribed.

“You have to look at outcomes, how many patient visits and how many hospitalisations,” Dr Pierre said. “This is how you manage compliance, how you manage physician performance.

“For those gaming the system, they can basically do all sorts of billings presently with no checks and balances.”

Dr Pierre spoke out just before the Bahamas Insurance Association (BIA) yesterday further increased the pressure on the Government over its decision to correct NHI’s ills, rather than start all over again.

The BIA, in its latest statement, argued that the NHI Secretariat was operating illegally as an unlicensed insurer by assuming the functions that would be performed by the scheme’s RHAs.

The RHAs are supposed to be the public insurer, BahamaCare, and private health insurers who would be contracted by the NHI Authority to pay doctors’ bills, adjudicate claims, monitor physician performance and standards, and prevent fraud and waste.

Yet with neither the NHI Authority nor any RHA in place, the BIA argued that the NHI Secretariat is breaching both its own Act and the Insurance Act by filling the vacuum.

“The BIA contends that the NHI Secretariat, acting on the premise that it can function as the NHI Authority (which has not been formally constituted), may have illegally taken on, among other things, the functions of an RHA as defined in Section 26 of the NHI Act,” the Association said.

“This would violate the NHI Act and, as the Secretariat would be carrying on insurance business, is also a violation of the Insurance Act.”

Once insurance industry source, speaking on condition of anonymity, told Tribune Business that the NHI scheme was “really, really mixed up” due to the Secretariat performing numerous, conflicting functions.

They explained that this meant patients and NHI medical providers had no recourse for complaints, such as those likely to have been made over doctor non-payment.

“In the absence of a proper regulatory structure, there is nowhere to go if patients have issues. Who do they go to?” the insurer asked. “That’s the conundrum and dilemma we find ourselves in. This is very unusual.”

“Had an insurance company failed to make payment, a complaint could have been filed with the Insurance Commission who has the legal power to investigate the complaint and to direct the company to resolve it,” the BIA said.

“The insurer in question could also have been sued for breach of contract. Under these circumstances, where the payments themselves violate law, the affected medical providers may not have any legal redress available to them.”

The insurance industry source also questioned whether the NHI Authority Board, and its members, will seek “indemnification” from the Government when appointed if they have to ratify actions that had no basis in law.

“What dangerous precedent are we setting?” they asked. “You do something outside the law, and then get it approved? We have to uphold the rule of law. We know something’s wrong and we need to fix it.

“The Minister is being very frank and honest in saying things were done unlawfully, but the challenge is: Do we continue perpetuating this illegality, or address it?”

Dr Sands, in a recent interview with Tribune Business, conceded that he and the Government were in “a hell of catch 22 situation” regarding NHI’s legal standing, and the former administration’s actions in launching the scheme.

“We had a choice,” he said. “We could have stopped it [NHI] cold. That’s what the pious among us said we should do.

“We’ve made a decision otherwise; to move as quickly as possible to get this thing operating properly, acknowledging there can be fraud and abuse and so forth. I can fume and pout that we’ve been put in a situation, but it doesn’t change it.”

Dr Sands added that “stopping NHI cold” would negatively impact persons who had left jobs to join the NHI Authority, plus private doctors who had signed contracts to provide medical services in good faith.