The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

National Health Insurance’s (NHI) assistant project director yesterday said the number of doctors registering to provide services was “not huge but reasonable”, amid ongoing ‘care quality’ concerns surrounding the scheme.

Dr Kevin Bowe told Tribune Business that the March 31 date for doctors to register to provide services under NHI was “not an absolute deadline”, adding that the scheme would “always be open” for new registrants.

He explained that the NHI Secretariat’s goal had to been to encourage a “first wave’ of physicians to sign up, so that the scheme has enough care providers to meet healthcare demand when the scheme launches next month.

Dr Bowe declined to give specific date for NHI’s introduction, which Prime Minister Perry Christie announced would occur in April, saying only: “That will be announced shortly.”

Besides doctor registration, numerous other components and infrastructure have to be put in place within a remarkably short period of time if NHI is to launch successfully.

Dr Bowe declined to comment on whether the Government had selected a private sector management company for NHI’s public insurer, Bahama Care, a contract that has been out to bid since August/September 2016, saying he was “focused on other components” of the scheme.

One source familiar with the status of the public insurer management contract, speaking on condition of anonymity, confirmed to Tribune Business that while it had yet to be awarded, it was receiving due consideration.

“That contract’s very much alive and under discussion,” the source said. “There’s been a lot of interaction with the preferred bidders, and ongoing part of the project.

“It’s very advanced, and you should be hearing something on that in a reasonable timeframe. It’s a significant contract.”

Nor has NHI’s governance structure been put in place by the proposed Bahamas Health Services Authority Bill, which calls for the Public Hospitals Authority (PHA) to be merged with the Department of Public Health to create a single overseer for the scheme.

With Parliament likely to be prorogued within weeks, if not days, ahead of the upcoming election, the Christie administration has an extremely narrow legislative window through which to move its NHI governance structure into law.

The Government has recently focused instead on the health system strengthening aspect of NHI, awarding numerous construction contracts to upgrade the public health clinics.

Asked by Tribune Business whether NHI would have sufficient registered doctors to launch successfully, Dr Bowe replied: “I believe that if one deals with it this way, the answer is yes.

“While it’s not a huge number of providers, it’s a reasonable number of providers.”

He was responding after Dr Sy Pierre, the Medical Association of the Bahamas (MAB) president, told Tribune Business last week that this nation’s best doctors are not signing up for the NHI scheme.

He said that while he had no ‘hard’ numbers, his conversations with high-level physicians and MAB members indicated that few, if any, were registering to provide services for the $100 million primary care phase.

“I’ve spoken to the consultant-level physicians, those who have specialist licenses,” Dr Pierre said, describing these as the likes of paediatricians, obstetricians, gynaecologists, and family medicine specialists.

“I don’t have any official numbers, but my feeling is that the top-level consultants are not signing up. The guys who are signing up are the GPs (general practitioners)......

“The lower tier physicians will take this; it will be an economic boon for them. But the primary care specialists, the experts, they’re telling me they’re not signing up because they can’t run a practice on what the NHI primary care phase is paying.”

Dr Bowe yesterday declined to categorise Bahamian doctors according to Dr Pierre, saying: “There are providers across the spectrum who are signing up with NHI and the process continues.”

He added that the NHI Secretariat was continually engaging the physician and healthcare industry on the scheme, amid suggestions by some observers that the $100 million primary care phase cannot be launched without sufficient private doctor buy-in to reduce the burden on the public sector.

Emphasising that March 31 was not a concrete deadline for completing doctor registration, Dr Bowe told Tribune Business: “I just want you to make this clear. This isn’t a deadline in terms of providers coming on as NHI registered.

“It’s an ongoing thing. “It’s not an absolute deadline. One can consider it as waves of providers signing on, given that we’re trying to prepare for the launch of NHI.

“This process is always open to providers; it never closes. When NHI begins, patients will have providers to choose from. We’re just capturing up to this point the first set of providers who say they wish to explore a relationship with NHI.”

Dr Bowe described NHI as a public-private partnership (PPP) involving private physicians, and said their registration - like the registration of the Bahamian public as beneficiaries - would never end.