The Tribune

• Ex-minister urges end to ‘medical apartheid’

• Urges nation to move past ‘deep state’ debate

• Calls for ‘doubling down’ on healthcare investment

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Bahamas will face a healthcare “disaster” if National Health Insurance (NHI) does not fulfill its potential, an ex-health minister has warned, urging: “We must get past this ‘deep state’ debate.”

Dr Duane Sands, who held the Cabinet post until mid-2020, told Tribune Business that “political buy-in” and access to the necessary financial resources were critical for the scheme to expand and meet its mandate of “ending medical apartheid” by providing affordable universal health coverage (UHC) to all Bahamians.

Acknowledging that critics will argue the government-run and funded scheme will prove unworkable, and be too costly for businesses and the economy to bear post-COVID-19, Dr Sands instead argued that The Bahamas must “double down” on increased healthcare investment following the pandemic.

He asserted that the “opportunity cost” of doing nothing to improve access to better health outcomes would be more expensive for The Bahamas in the long-run than taking action via NHI now, even though admitting that his nation already spends more on healthcare than most other countries.

Dr Sands said The Bahamas was spending its healthcare dollars “unwisely” through a focus on tertiary-level hospital care, concentrating resources on serious and potentially life-threatening illnesses. Such an approach, he argued, “trivialises primary care” and makes it difficult for Bahamians to access preventative care and wellness strategies much earlier.

Pointing out that NHI was intended to address these weaknesses, the former minister told this newspaper: “NHI had a pretty bold and progressive concept to achieve universal health coverage. It wasn’t a matter of what; it was a matter of how. We had a lot of discussion about financing options and so forth.

“In my last House of Assembly contribution I made it very clear that even in these difficult times we ought to be strengthening the role of NHI to provide primary care coverage and catastrophic. Catastrophic is going to be more difficult, but it’s very important to the public.

“NHI has the infrastructure, the technical know-how and it has leadership. It’s just a matter of whether it gets the political buy-in and funding.”

Many observers, though, have voiced concerns that the increased primary care funding directed through NHI will not be effective unless the public health system’s crumbling infrastructure is first addressed. NHI this week said it aims to cover 61 percent of the population by 2025, with this expanding to 90 percent via private insurers.

Dr Sands, though, called for the debate to move beyond arguments over whether NHI is necessary and fears that it will merely represent a further drain on hard-pressed Bahamian taxpayers. “This has been a long time coming. What we need to do is look at the opportunity cost of doing it and the opportunity cost of not doing it,” he told Tribune Business.

“Not doing it would be a disaster. If you look at the value of any investment made in primary care, not only in maintaining a healthy workforce and healthy population, we are going to pay less by health prevention and maintenance strategies, and a few appropriately placed contingency strategies, than by having to pay clean-up with people suffering illnesses in an advanced state that have been neglected.

“There is a very famous advertisement: You pay for it now or pay even more later. It’s a matter of whether we pay for it when it’s manageable or pay for it when it’s in a disastrous state.”

Dr Sands added of NHI’s advance: “I also realise it’s going to generate a large hue and cry, arguments about the deep state and that it’s too expensive, and we can’t afford. I get it. There’s a real philosophical discussion as to how far we should go.

“This is one of those things we need to get beyond. In my view it will cost far less to do it than either maintain the status quo - and we pay a disproportionate price for healthcare now, more than most countries in the world. We’re paying the price now of an unhealthy population, and there’s no equity in our approach to access to healthcare.

“You’ve heard me describe it as medical apartheid. I stand by that. Medical apartheid should be eliminated. At the moment, those that can afford it get it, and those that cannot don’t. It’s going to be a challenge. There will be pundits that raise holy hell about ‘tax and spend’ and so on and so forth,” Dr Sands continued.

“This is one of those philosophical discussions about whether we believe healthcare is a right or a privilege. Particularly in a post-Dorian and post-COVID environment, if we say we have precious few dollars and scarce resources, certainly we should double down by investing in the health of our people.”

As a practicing physician, Dr Sands said he saw patients “with catastrophic life-threatening illnesses on a daily basis”, such as heart attacks and strokes, who simply were unable to access the necessary healthcare because they do not possess the insurance coverage or other financial resources.

“It’s a terrible reality in a country that is as developed as we are,” he added. “It speaks to the model we gave chosen to adopt. It’s not because we’re not spending money. We’re spending far more money than many countries do on healthcare. It’s just that we’ve spent it unwisely.”

The bulk of the Government’s $300m-plus annual healthcare spend, around $220m, goes to the Public Hospitals Authority (PHA), and Dr Sands said: “We have a system that benefits tertiary care, which trivialises primary care and which makes it challenging for people to get access to preventative care to avoid complications with diabetes and hypertension and the like.

“It limits access to healthcare until we have a disaster on our hands. Our intensive care units (ICUs) are full for no reason other than people neglect their diseases until it is too late. I put it to you that the economy is paying the price right now.

“We are paying for it by having to support families that have lost breadwinners, having to provide expensive care through the public healthcare system, providing huge amounts of money for that system, paying for dialysis and disabled care. I could go on and on.

“There’s been study after study that demonstrates a healthy population is less expensive to manage, and a more productive population. It’s easy to make the statement about being too expensive when you have private health insurance.”

To prove the point, Dr Sands said he had just seen a woman suffering from a life-threatening illness that was treatable but she was enduring “holy hell to get access to care” because she lacked the financing and it was not available in the public system. “Our system will penalise her for lack of resources,” he added.