The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Bahamas Insurance Association's (BIA) chairman has warned that the public healthcare system remains the revamped National Health Insurance (NHI) scheme's "Achilles heel".

Emmanuel Komolafe, pictured, in an interview with Tribune Business, reiterated previous private sector alerts that the Government's NHI objectives of broadening access to quality healthcare, and improved outcomes, will be undermined unless the existing healthcare system is strengthened.

"The reality is that our funds are finite and resources are limited," he said of the realities facing the NHI scheme. "Hence, significant reliance will have to be placed on the public healthcare system; in particular, healthcare facilities under the oversight of the Public Hospitals Authority (PHA).

"This is why there has to be collaboration and a shared vision for healthcare in The Bahamas. The PHA will play a major role in determining the quality of care delivered under the High Cost Care programme [for catastrophic illnesses]. The public healthcare system, if not strengthened and upgraded, may very well be the Achilles heel of the revamped programme."

Such warnings were sounded on multiple occasions under the Christie administration only for the then-government to largely ignore them as it raced to roll-out NHI before the May 2017 general election in a last-ditch bid to deliver on prior promises.

"There has to be heavy reliance placed on the public healthcare system," Mr Komolafe added. "The limited resources mandate they take such an approach, and place significant reliance on the public healthcare system - and delivery in the public health system - to be successful.

"In our discussion on NHI, the elephant in the room is often the cost of healthcare and the state of the public healthcare system. The success attributed to the primary care phase of NHI can be linked directly to the healthcare cost management measures (via capitation) and the participation of the private healthcare sector. By leveraging resources and infrastructure within the private sector and controlling the cost of these services, the NHI programme has been able to maintain its viability to date.

"Unless these key elements of the primary care phase can be duplicated by the NHI Authority, the revamped scheme - which aims to cover catastrophic care - will be challenged. ‎The distinguishing factor here is that there is more at stake with secondary and tertiary care being covered. As we are all aware, the proposed health conditions to be covered account for a great proportion of healthcare costs in The Bahamas."

But Dr Duane Sands, minister of health, told Tribune Business it was "a significant assumption that the public healthcare system will have to carry the burden", pointing out that NHI would a provide a potential revenue source that the Princess Margaret Hospital (PMH) and other PHA facilities currently lack.

"The public healthcare system rarely, if ever, is the recipient of private dollars," the Minister said. "Imagine an increase of $20m, $30m, $40m directed to the public sector. That's $40m we don't have, which translates into a return to the PHA.

"That provides a huge ability to improve services, the recruitment of providers, doctors and nurses, improving the infrastructure."

Mr Komolafe, meanwhile, called for healthcare reform to be an "holistic" process that focused on wellness and preventative care, as well as the Government's taxation policies towards the industry.

"On the other side of this discussion is the fee schedule agreed upon by healthcare professionals and practit‎ioners," the BIA chairman told Tribune Business. "The affordability and access to quality healthcare will be impacted by the fees agreed by medical practitioners.

"This fee schedule will ultimately become the national medical fee schedule and will apply to not just the Standard Health Benefit (SHB) but all health insurance policies issued in The Bahamas. It is the only way we can successfully bend the healthcare cost curve. We will all have to find common ground to make this programme work.

Mr Komolafe added: "Health insurance premiums will fall automatically ‎with a reduction in the cost of delivering the healthcare. There are also mechanisms available to the Government to control the cost of health insurance in The Bahamas, including the regulation of loss ratios.

"However, the Government can reduce the cost of healthcare and health insurance premiums immediately by changing its policy in relation to the taxation of healthcare and health insurance premiums. In the case of the latter, we are talking about a 3 percent premium tax plus 12 percent VAT.

"Concurrently, the taxation of healthy foods must be addressed to make it more affordable for people to maintain a healthy lifestyle. This must be considered in conjunction with initiatives within the ministries of Education, Social Services and Agriculture. The main point is that we must adopt a holistic approach to healthcare reform in The Bahamas."