The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

AS the enrollment phase of National Health Insurance (NHI) nears, senior doctors are still seeking answers to a long-held question: what about the healthcare system and culture in the Bahamas will truly change when NHI is introduced?

The 90 or so members of the Consultant Physicians Staff Association (CPSA) are among the most senior and high-ranking medical professionals in the country.

In a recent press statement to The Tribune, they acknowledged that communication between themselves and NHI officials has improved. They stressed that they remain committed to improving health services in the country.

But as the deadline for provider registration closes tomorrow, signalling that the enrollment phase of NHI scheme could then begin, the CPSA says it remains concerned about elements of the existing system.

Although the government has focused on strengthening healthcare facilities around the country, for instance, the CPSA seemed to question if sufficient emphasis has been placed on ensuring that there is necessary manpower to provide medical services.

The group said: “Both consumer/patient and provider should be asking, ‘what am I to expect (about healthcare services) that (will be) different (from what I experienced before)?’ As previously stated (by this group), primary care in the Bahamas already follows the template of ‘care for all without discrimination’. In the Bahamas, a major problem is accessibility.

“Traditionally, the focus has been on improving facilities in Nassau. Limited facilities exist in the (Family) Islands. Many persons know that building a clinic in South Andros without proper personnel is wasteful. In 100 mile-long Eleuthera there is one physician.

“Do we instead need one physician for every 25 miles? In the clinics, timely availability of medication is a challenge, forcing islanders to turn to Nassau for their supply. In reference to communities that are off the mainland, what is the plan to ensure their access will be no less than someone living in Pride Estates?

“The government has undertaken a health strengthening exercise and, as advised by foreigners, it has built clinics and implemented electronic medical records systems that cost millions of dollars. Ultimately, however, to ensure delivery of quality healthcare, appropriate, qualified manpower is needed, and attention must be given to reasonable provision for accommodation, transportation and reimbursement.

“Otherwise, when National Health Insurance is implemented, the noise in the marketplace (will become) another empty promise to you, the Bahamian patient.”

The CPSA also expressed concern about the scope of benefits that will be provided under NHI.

Some government officials acknowledge that a major challenge with its NHI scheme will be managing expectations of Bahamians who may not appreciate that only limited coverage will be provided through primary care services. After primary healthcare is implemented, the government hopes to implement its Essential Benefits Package sometime later, which will provide more comprehensive services.

However, the CPSA said in its statement that separating primary care services from more comprehensive ones will create a new set of challenges.

“It is guaranteed that, in the first seven to ten years, the number of persons requiring advanced, expensive, financially demanding care shall increase,” the CPSA said. “This number shall require input from more than just a primary care physician.

“The diabetic person with kidney problems, glaucoma, retinal damage, heart problems, joint issues, and hypertension, these patients will require drugs, rehabilitative services, diagnostics, dietary service and health coaching on how to achieve and live a healthy life, for example. Without including these facets of healthcare in the scope of benefits, NHI funds will not truly improve health outcomes.

“It is gratifying to our association that the current government has accommodated and, to an extent, considered the concerns (this group has expressed). Catastrophic care has subsequently been given a budgetary allocation. The concern we have is whether our premier health delivery facilities will be adequately included in this exercise, not just used as a safety net or a dumping ground when the effort fails at other facilities.”

Finally, the CPSA urged government officials to have regard for the expertise and experience its members.

“A concern of the CPSA and its members is not the number of providers who have signed on to participate in the NHI scheme, rather it is the continuation of the divide and conquer methodology, misinformation, coercion, enticement, intimidation and bullying being used to obtain signatures,” the group said in its statement.

“Senior, qualified physicians in this country expect no less respect than a QC, the judiciary or policy-makers and demand due respect for their experience, input and support for a less than ideal system. Many persons have worked for more than ten years in the system, having willingly sacrificed diverse opportunities to serve our Bahamian people.”