The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Minister of Health has been forced to increase the stress on “an already over burdened” public healthcare system to ensure equality for National Health Insurance’s (NHI) 25,000-plus beneficiaries.

Dr Duane Sands told Tribune Business he had signed an ‘executive order’ to ensure NHI patients can access secondary and tertiary level care within the public healthcare system, potentially adding to waiting times for vital treatments.

He argued that this had resulted from the Christie administration’s poor NHI planning, which had neglected the “parameters” for secondary and tertiary care and how this would be integrated with the Princess Margaret Hospital (PMH) and Public Hospitals Authority (PHA).

Patients currently have to be seen by a doctor accredited with either the PHA or Department of Public Health before they can be referred to PMH for diagnosis and specialist care.

However, many NHI patients are outside this system because they are being seen by the estimated 50-60 private doctors registered as primary care providers under the scheme.

As a result, Dr Sands said it was necessary for him to sign a “directive” permitting these patients to access secondary and tertiary-level care within the public healthcare system without first being seen by a PHA or Department of Public Health-accredited doctor.

“One of the challenges we’ve had is what to do with NHI patients who, identified as having problems at the primary care level, have to be referred somewhere to where these problems can be addressed,” Dr Sands told Tribune Business.

“At this time, NHI patients do not have tertiary care coverage or benefits. These patients have to be referred back to the public healthcare system. They join the line at a point in the system, and exacerbate an already over burdened and overcrowded system.”

The Minister said this was precisely the opposite effect of what NHI was intended to do - reduce the burden on a struggling public healthcare network and infrastructure by enabling more Bahamians to access treatment in the private sector.

“If the waiting list for cardiology or urology diagnosis is several months, what happens to those lists if hundreds or thousands of patients enrolled by NHI are added to it, but we’ve not built in the capacity to deal with them?” Dr Sands asked.

“The present roll-out of NHI has done exactly what we anticipated it would do; increase the over-burdening of an already overcrowded healthcare system.”

Dr Sands told Tribune Business that had he taken no action, NHI beneficiaries could have effectively been given ‘second class status’ when compared to patients referred for secondary and tertiary care via the normal channels.

This could have resulted in them waiting longer, and being given a lower priority. “What I have done is issue a directive to allow patients seen by NHI clinicians to enter the public healthcare system for diagnosis and consultation without having to see a Department of Public Health or PHA physician first,” the Minister confirmed.

“Otherwise a patient seen by a private NHI doctor, having been identified with a problem, would have no means of referral. They would have to see a PHA physician first.”

Bahamian medical professionals confirmed that the issue had been causing increasing concern in the healthcare industry prior to Dr Sands taking action.

Dr Sy Pierre, the Medical Association of the Bahamas (MAB) president, told Tribune Business that the problem was resulting in the “duplication of services” - again, the very thing NHI was supposed to avoid.

He explained that Dr Macumba Miller, head of the Bahamas Doctors Union (BDU), which represents junior doctors in the public healthcare system, had informed him that the government-run clinics immediately prepared and referred patients diagnosed with serious ailments to PMH.

Yet under NHI, this was viewed as “specialist care”, with the clinics unable to perform the preparation/referral function for patients enrolled in the scheme.

Dr Sands told Tribune Business that the confusion, and his action in overriding the system, could have been avoided had the Christie administration properly planned and thought-out NHI’s structure and operations.

“The road to hell is paved with good intentions,” he said. “Had this thing been carefully thought-out, considered and appropriately planned, we would not be having these problems.”