The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A Cabinet minister yesterday confirmed that the Princess Margaret Hospital (PMH) is still targeting fee increases to make up a $40m funding shortfall in time for the upcoming fiscal year.

Dr Duane Sands, minister of health, told Tribune Business that while the Public Hospitals Authority (PHA) had already decided to raise fees, which ones - and the extent of any increase - had yet to be determined with the Ministry of Finance and Cabinet.

He added that PMH was also still working on the necessary infrastructure to properly code and bill patients/insurance companies for services rendered, with the new business office and staff recruitment both still in process.

Reiterating that “the insatiable demand for healthcare services” among Bahamians was “not matched by a willingness to pay” for them, Dr Sands said raising the necessary extra revenues on top of the PHA’s annual $217m Budget allocation was not as easy as initially thought.

He added, though, that the necessary investment had to be found if The Bahamas was to “stay abreast of new developments and healthcare technology” while meeting the demands of an expectant publication.

Asked how far PMH and the PHA had progressed on efforts to implement up to 500 new and increased fees, as previously suggested, Dr Sands told Tribune Business: “We are still working out these proposals.

“At the end of the day, it’s really going to come down in its entirety to what happens with the budget’s allocation towards health and what we’re going to propose to do in terms of shoring up revenue. We know what it costs to do the things people need and want. The question is: How are we going to pay for it?

“We are definitely walking down that road where we have agreed to adjust the fee schedule. To what extent, and the specific fees, remains a work in progress. We’d like to be able to synergise or harmonise those with the budget. We’d like to be able to know in the fiscal year 2019-2020 how we are going to be able to meet the mandate required or requested by the public.”

With the PHA’s costs and spending levels already known, Dr Sands added that the next step was to work out “how do we get the revenue to pay for it” given that annual budget allocations were now unable to cover the necessary expenditure.

“It’s a very real challenge,” he told Tribune Business. “There’s a nearly insatiable demand for healthcare services, but the demand for healthcare services is not met by a comparable willingness to pay for these services.

“There’s not a whole lot of elasticity or flexibility in the financing of these services. Cat scans, MRIs, neurosurgeons, cardiologists, gastroenterologists...these things have specific costs. Infrastructure maintenance and capital investment, these things have certain costs.

“All these things we can price, budget and work out to a specific dollar amount. It’s more than the $217m allocation to the PHA in the 2018-2019 budget.

“New technology has costs, and if we are going to keep abreast of new developments, new healthcare technologies, it means we have to invest. Training of doctors, allied healthcare staff, has specific costs associated with it.”

Dr Sands said “one of the simplest things we may have to do is enforce the existing laws”, pointing to multiple fees that had been “gazzetted” and placed into law years ago but never enforced.

While public health matters such as HIV treatment, heart disease and dialysis treatment were likely to be financed from the Government’s consolidated fund via the Budget, Dr Sands said obtaining revenue from civil servants and other public servants on whose behalf it paid health insurance premiums had been complicated by existing trade union agreements and policy.

“We also need the capacity to code, collect and bill that revenue,” he told Tribune Business. “The business office is being built as we speak, individuals are being recruited as we speak. But it does not exist as of this date.”