The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Medical Association of the Bahamas (MAB) president believes it will be possible to “hammer out” a catastrophic health insurance plan, but emphasised: “You can’t look at healthcare in a vacuum.”

Dr Sy Pierre told Tribune Business that the Minnis administration’s plan for “a progressive and functional” catastrophic NHI programme could be achieved, provided it abandoned its predecessor’s approach and properly involved healthcare industry stakeholders in its creation.

Suggesting that the definition of ‘catastrophic care’ was key, Dr Pierre suggested it was better to determine this by monetary value rather than type of illness.

“I guess we have to sit down with them [the Government] and see what they’re calling catastrophic care. It depends on what you define as catastrophic care,” the MAB president told this newspaper. “You can use a diagnostic code, or [base it on] the amount of money that breaks a family financially and emotionally.

“It’s probably better to put a monetary value on it rather than a diagnostic code. You have an idea of what it’s going to cost. It’s going to be limited by the amount of money, but if everybody works together it’s doable. If we can work together we can hammer out a catastrophic healthcare plan.”

The Free National Movement (FNM) has long sought to introduce a catastrophic health insurance programme, the issue having first emerged on the policy agenda under the 1997-2002 Ingraham administration.

It returned in last week’s Speech from the Throne, in which the newly-elected government promised to “oversee the incremental implementation of a progressive and functional National Catastrophic Health Insurance Programme”.

This marks a change of emphasis from the former Christie administration, which was focused on primary care via the $100 million roll-out it initiated just prior to the May 10 general election. While promising not to drop NHI altogether, the new government is promising to make it work better and extend it to secondary and tertiary care.

While intended to save lives, and protect Bahamian families from financial ruin and endless fund-raising cook-outs, several health professionals have warned that a catastrophic insurance programme is extremely difficult to design because of the sheer costs involved.

Millions of dollars in costs can be incurred by very few patients, which is why many healthcare professionals queried the limited $20-$25 million sum assigned to cover catastrophic treatments under the Christie administration’s $100 million NHI primary care roll-out.

Dr Pierre, meanwhile, reiterated that healthcare and its affordability was a function of the wider Bahamian economy. “If you have a meaningful economy with good jobs and low unemployment, there’d be no issue,” he told Tribune Business.

“That has to come first. We need the rule of law, a proper education system, and a diverse and free economy. Once we have those things, healthcare will fall into place, as you have a large captive market for insurance. That’s where people get lost, because you can’t have healthcare in a vacuum. If you have 20-30 per cent of the population trying to fend for themselves, it’s not going to work.”

Dr Pierre also urged the Government to relieve the Value-Added Tax (VAT) burden on the healthcare industry, arguing that the Bahamas was possibly “the only place” where the tax was levied on healthcare and health insurance premiums.

“You can’t ask us to do work for the public and hit us with large amounts of tax,” he added. “Something as simple as that would remove a large burden on physicians. Again, you can’t look at it in a vacuum.”

The MAB president said the NHI rates proposed by the Christie administration would have slashed doctors’ hourly pay below that of electricians and plumbers. “That was ridiculous, $36 per hour,” he told this newspaper. “Something like that was not going to work, no matter how hard you try.’

He also took a swipe at the Christie administration’s last NHI consultants, the KPMG accounting firm, saying they had tried to impose a system based on the UK’s National Health Service (NHS), which is beset by problems - including a physician’s strike earlier this year.

“These are the same people trying to tell us this the system we should have, and theirs seems to be an abject failure,” Dr Pierre said. “We’re communicating with Dr Sands, and hopefully in the not too distant future the MAB and other stakeholders can sit down and see were we’re going with this, and what the expectations are on their side and what they are on our side.”

Dr Duane Sands, the minister of health, was a major NHI critic while in Opposition. “They’re trying to figure out what was law and what was fluff under the previous administration,” Dr Pierre added. “They’re trying to get a handle on what was put into law or not, and see where they go from there.”