The Tribune

• Sands: Place $290m Nassau hospital on hold

• And focus on NHI catastrophic ‘game changer’

• $170m-$210m ‘price tag’ not as high as feared

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Opposition’s chairman has backed the Government’s pledge to introduce National Health Insurance’s (NHI) catastrophic care component as “a game changer”, but warned: “We cannot do it all.”

Dr Duane Sands, a former minister of health, told Tribune Business that The Bahamas “cannot afford business as usual” when it comes to healthcare given the near-impossible “challenge” many Bahamians face to both afford and access potentially live-saving treatments for catastrophic illnesses.

Pointing to the “massive drag on productivity” and wider economy that results, he disclosed that the costing exercise performed when he held ministerial office found catastrophic care’s “price tag” under the NHI scheme was not as high as predicted, with the total expense coming in at between $170m to $210m per annum.

Urging the Davis administration not to “reinvent the wheel”, and carry on the work performed by its predecessor, Dr Sands acknowledged that “the devil is in the detail” as to how the Government plans to implement an NHI catastrophic care component that has been “an elusive goal for a very long-time”. 

And he also effectively called on the Davis administration to place its proposed new $290m New Providence hospital at Perpall Tract on hold, arguing that there is insufficient funding to accomplish all its healthcare goals and it will have to prioritise its objectives.

The Speech from the Throne, which lays out the headline or broad brush objectives of the Government’s legislative agenda, last week pledged that the Davis administration is “moving aggressively to implement the second phase of National Health Insurance, with the introduction of catastrophic healthcare cover. This will make healthcare more affordable for all Bahamians”.

While no specifics on how this will be accomplished, or the associated timelines, were provided, Dr Sands told Tribune Business: “I think if they are able to accomplish it, it will be a game changer. It [catastrophic care] was a major plank in the FNM’s 2017 platform but we did not accomplish it. This was something that I believe is very important, and I continue to believe is very important.

“When we did the costing evaluation, and we did a tremendous amount of groundwork for advancing universal health care (UHC), including primary care and catastrophic care, the price tag was found not to be as large as thought. It wad found to be between $170m and $210m.”

The former health minister said the then-NHI Authority Board, chaired by Dr Robin Roberts, “did a phenomenal amount of work in terms of advancing the concept. The Board did yeoman’s work, and it would be a shame if that work was allowed to collect dust.

“We went so far as to get costing of the product, how it would integrate with private health insurance, and would do a tremendous amount to advance private healthcare in the country and to provide a sustainable means of funding healthcare in the country,” Dr Sands added.

“Government is continuous, and even though the NHI Authority is a quasi-government agency, it has continued to grow. There has been a huge uptick in demand for NHI, the primary care component, and now I think it’s time to expand it again given the challenges people face, particularly if they encounter heart attacks, kidney failure, strokes or cancers.”

Dr Sands described The Bahamas’ present healthcare model, where private and public healthcare co-exist side by side, as akin to “medical apartheid” because while clients of the former typically enjoy health insurance and can thus afford hospital-level catastrophic care those in the latter often cannot. Successive administrations have spoken about the need to end cook-outs and other ways of raising funds for those who cannot afford critical treatments.

Conceding that NHI’s proposed expansion will likely provoke some opposition, the FNM chairman added: “This is something that has been an elusive goal for a very long time. People will cry bloody murder when they first hear about it, but I think this is an appropriate and necessary step in a civil society.

“Obviously, the devil is in the detail. This is one of those things where it is less an issue of whether we can afford it or repurpose the incredible spending we have, much of which is wasted. The Bahamas spends more money on health that most countries in the world. Part of that is due to the fact we have a horrible health profile that has been recorded over and over.

“We cannot afford to continue business as usual because of the massive drag on productivity, costly treatments, dialysis treatments, air ambulances. The idea that we provide everybody with with insurance, whether underwritten by the NHI Authority or third party payers, and elevate the quality of healthcare everybody gets, it allows us to become more competitive in retaining nurses and allied professionals,” Dr Sands continued.

“It’s [catastrophic care] absolutely the right target. Now let’s see how they are going to get there. This is an opportunity for collaboration and looking at the work that has been done. A huge amount of work was done with the support of the Ministry of Health and Pan-American Health Organisation (PAHO). Don’t reinvent the wheel. The work has been done. If they have prioritised it, let’s get it done.”

Dr Sands, though, argued that the Government’s healthcare reform agenda is over-ambitious and too expensive, especially given the challenges it faces in securing the necessary financing with The Bahamas presently effectively cut-off from raising funds via the international bond markets because the interest rates demanded by investors are too costly.

“The one challenge that exists is how they will get it done when the National Insurance Board (NIB) finds itself in so much trouble,” the former health minister told Tribune Business. “The other problem is there are some misguided capital projects being considered, so we can’t do it all.

“They are talking about a new hospital in the face of a Critical Care Block at Princess Margaret Hospital that they cannot maintain. You cannot build a new hospital in Grand Bahama, build a new hospital in Nassau, expand NHI, save NIB, build a new prison. We’re in the middle of an international bond crisis so the cost of raising money is infinitely much more expensive if not impossible.

“I don’t know what they’re smoking, but they’re not going to be able to do everything.” Asked what the Government should focus its healthcare plans on, Dr Sands implied that it should not be a new hospital for New Providence.

“If they’re going to prioritise, it might be in the first instance trying to get the healthcare system working, focusing on getting Grand Bahama’s secondary and tertiary care up to scratch, getting the critical care block at Princess Margaret Hospital working as it should and go back to the phased expansion plan agreed for years, and focus on retaining nurses,” he added.

“I think they will find that, and strengthening the primary healthcare system, will give them far more bang for their buck. Catastrophic care is absolutely necessary. We have hundreds and hundreds and hundreds of people on dialysis right now, and no sustainable means of paying it.”

The Davis administration tabled a revised NHI Bill in the House of Assembly in October 2022, with the intention that it would repeal and replace the existing 2016 Act. It sought to make the scheme’s Standard Health Benefit the minimum level of insured medical care for all Bahamians whether they are covered by private insurers or NHI.

The Bill ran into opposition from the Medical Association of the Bahamas (MAB), which represents private physicians, urging that the Government “hit the pause button” and stating that it “cannot support the Bill” in its present form. However, the Bill never move forward, and the proroguing of Parliament this summer meant that all outstanding legislation at the time was discontinued.

The Davis administration is now likely to resuscitate the legislation and bring it forward for tabling in the new session, based on the Speech from the Throne.