The Tribune

• Medical Association ‘cannot support Bill’ as is

• Warn against rushing and ‘sham consultation’

• Say Authority’s powers are ‘too wide-reaching’

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Bahamian doctors yesterday urged the Government to “hit the pause button” over its proposed National Health Insurance (NHI) reforms, warning they “cannot support the Bill” tabled in the House of Assembly as is.

The Medical Association of the Bahamas (MAB), which represents private physicians throughout The Bahamas, told Tribune Business in a statement it was “distressing” that the Davis administration had proceeded to table the NHI Bill for its first parliamentary reading without giving those impacted a chance to provide full feedback and advice.

Warning that the legislation “must not be rushed”, and there can be “no sham consultation”, the Association added that it had no desire to unduly delay NHI’s expansion or the provision of healthcare to the Bahamian people.

But it said physician compensation must be got right, and warned that the powers granted to the NHI Authority - the body charged with overseeing the scheme - were “simply too wide-reaching” and could infringe on the rights of both patients and medical providers.

Suggesting that the Government was looking at “a deep dive into socialised healthcare through NHI” based on the Bill’s current contents, the MAB said the implications need to be properly and fully considered given the “potential adverse consequences” for the healthcare industry and Bahamian people.

The statement, responding to Tribune Business inquiries, said: “The tabling of the new NHI Bill in Parliament last week is a welcome reminder that substantial ongoing investments in the health care sector are the key to providing high quality, accessible care to Bahamians. Everyone in need of healthcare services should get the appropriate treatment at the right place and at the right time.

“What we must recognise, however, is that healthcare providers are part of a complex local ecosystem. Without adequate consultation with the medical community, which includes the physician providers at the helm, the NHI programme cannot meet its mandate.

“It is distressing to members of the medical community that the new Bill was tabled without affording us the opportunity to engage with the drafters and provide essential input from the perspective of the physicians who offer the services to the public,” the Association continued.

“We are the ones who have direct contact with the patients and, in so doing, we are assured that we are best-suited to advise on legislation from the realities of practice. We are the ones who know what works and what will not work based on our collective experience working in the private and public medical sector in this country.”

Reiterating that it was not opposed to better healthcare access and treatment outcomes for Bahamians, the Association said: “We do not seek to restrain expansion of the programme. What we do seek is a seat at the table to offer our suggestions, which are borne out of experience as practicing healthcare providers. The consultation with physicians must be adequate and not just a sham, as we have a very important part to play and should not be taken for granted.

“In its current form, we cannot support the NHI Bill that has been tabled. We ask that the Government hit the pause button and come to the table to consult with those who deal directly with the patients who are receiving service through the scheme. The process must not be rushed. The NHI service should be offered at the right compensation for providers, and this can only be determined with input from practicing physicians.

“Amongst other things, important questions of patient confidentiality, the constitutional rights of both providers and beneficiaries and the role of private insurance carriers under the scheme must be addressed. The section 8 ‘power of [NHI] Authority as it stands is simply too wide-reaching. It states that a physician can be found to have committed an offence if he/she refuses to comply with a direction by the Authority to divulge ‘any record or supply any information’ requested.

“It appears that there is an intended deep dive into socialised healthcare through NHI looking at the current state of the Bill. In all the circumstances this is a path that must be more carefully considered, in light of the potential adverse consequences for the healthcare sector, the citizenry and the country as a whole.”

The Association’s position is likely to prove another headache for the Davis administration, which has just had to contend with furious opposition to its proposed price control expansion and mark-up cuts from both the food and pharmaceutical industries. Both those sectors assert that they were not properly consulted before the reforms were unveiled, and now Bahamian doctors and physicians are making similar complaints.

Dr Michael Darville, minister of health and wellness, in tabling the NHI Bill in the House of Assembly said the Government had released the legislation to give the healthcare industry, medical insurers, the private sector and civil society an opportunity to provide the Government with feedback and advice. 

While three meetings are understood to have been held over the Bill between October 6-13, 2022, involving the Association, its members and the NHI Authority, this newspaper understand that these were only held at the MAB’s request after it discovered that the Davis Cabinet had approved the legislation and its tabling in the House of Assembly.

Dr Conville Brown, principal of The Bahamas Heart Centre, Cancer Centre Bahamas and The Medical Pavilion Bahamas, forecast to Tribune Business on Monday that the Government “is going to have some challenges with the medical community” over the Bill and that prediction already appears to be coming true.

The legislation, which will repeal the existing NHI Act 2016, was described to this newspaper by another doctor - speaking on condition of anonymity - as the next step in the Government’s “stealth takeover of the healthcare industry” since it seeks to introduce price controls similar to those that have roiled the food and pharmaceutical industries.

The Bill seeks to ensure that all Bahamians and qualifying residents have access to a minimum level of healthcare, known as the Standard Health Benefit, which includes primary healthcare services, diagnostic imaging, and screening programmes for cancer and other “specified conditions” among the services offered. However, it also seeks to dictate the premium prices that insurers can charge for the Standard Health Benefit, and the fees received by doctors.

Its section seven, entitled “powers of authority”, stipulates that the NHI Authority, the regulatory body charged with overseeing the scheme, has the power “to fIx fee schedules and payment rates for Standard Health Benefit providers (doctors and physicians”. And the same section states that the Authority can also “regulate the maximum price by approved insurers for benefits rendered under the standard health benefit”.

The fee schedules, payment rates and “maximum price” were not disclosed in the Bill. One doctor, spoken to by this newspaper yesterday, said these were equivalent to price controls and will have the same effect as those concerning food retailers/wholesalers and their pharmaceutical counterparts - that of potentially forcing physicians to provide services covered by the Standard Health Benefit at a loss if they are set too low.

“This is the Government’s stealth takeover of healthcare,” the doctor said. “That’s what they’re doing with physicians and primary care. They’re coming in and telling us as medical practitioners what to charge, and what our overhead costs are, without consulting us. They’ve never had a word with us.

“The Government is steadily positioning themselves for a takeover of the healthcare system in The Bahamas and physicians, pharmacists, allied health care professionals and the insurance industry are going to have this imposed on them if they are not careful and allow them to completely derail the system.”