The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

An ex-health minister and the Bahamas Medical Association’s (BMA) president yesterday both suggested that “abuse” may have caused National Health Insurance (NHI) laboratory benefits to be capped.

Dr Duane Sands, now the Free National Movement’s (FNM) chairman, and Dr Gemma Rolle each told Tribune Business that oversight and controls over medical testing carried out on behalf of NHI beneficiaries may have been lacking and prompted the intervention by the Authority administering the scheme.

Speaking after it was revealed that “caps and limits” are to be imposed on NHI’s laboratory tests benefits package from October 2024 onwards in a bid to control “escalating costs”, Dr Sands said: “I’m not in the slightest bit surprised...

“I couldn’t see how they could not have put the brakes on this runaway train. I am surprised they haven’t done it sooner. It was one of those gaps in oversight that I am sure they have a massive hole now. They opened it up to ‘discretion’, and discretion translated into revenue; unrecognised revenue.”

Explaining what he meant by this, Dr Sands indicated that oversight weaknesses in the NHI scheme had created opportunities for some doctors to establish their own so-called “pop up” laboratories to conduct medical tests for patient beneficiaries.

“It is a problem that, on the one hand, the oversight, the management of the programme left something to be desired,” he added. “Second, sadly it gave an opportunity for a number of so-called ‘pop-up’ laboratories, and those laboratories started doing testing. These were labs in doctors’ offices.

“It became a revenue set-up for a lot of people. I don’t know if it translated into a drastic improvement in quality. Suffice it to say that NHI was already challenged to keep up with its funding and now I doubt they’ll tell us how big this hole is but I suspect it’s a big one so they’ve put the brakes on. I am not surprised that NHI finds itself in the state that it’s in.”

Dr Rolle, meanwhile, took a more measured view of the NHI Authority’s move. “There’s going to be some growing pains with NHI,” she said. “Anything that’s new to a country or a system there’s going to be some things you try to foresee; obstacles prior to the implementation, but it isn’t until it starts going that you realise that there are some things you don’t necessarily see coming and now it’s happening.”

Pointing out that private health insurance companies impose caps/limits on the amount of blood work and other lab tests for which patients are covered, the MAB president added: “What NHI is working on is seeing how there can be some control and regulation of how these tests are conducted and utilised.

“Let’s say you do a particular test every month. Who’s paying for that? There’s a cost associated with that. Let’s see how we can maximise on utilisation of NHI without abusing certain functions of it. While they get more control of that, let’s onboard more physicians, patients and keep it moving.....

“We do understand there are going to be some obstructions, we do understand this is something quasi-governmental, we do understand that funding may play a role, but we remember we are doing this to serve our people and help those that are disadvantaged and help those that otherwise would not be able to afford healthcare on their own.”

The NHI Authority Board’s notice, dated August 12, 2024, was billed as seeking “to convey the critical decisions finalised by the NHI Authority Board of Directors regarding the fiscal 2024-2025 Budget allocation and its impact on service delivery in the future.

“Due to the Government of The Bahamas’ broader fiscal management priorities, and to ensure the programme’s sustainability, the NHI Authority Board of Directors has directed the following cost containment measures in its fiscal 2024-2025 Budget allocation,” the NHI Authority Board warned.

“Starting in October 2024, the NHI Authority will introduce caps and limits to the laboratory benefits package to better manage escalating laboratory costs. Awareness campaigns will be launched to inform beneficiaries, providers and the public about these new measures.

“Expansion of the provider network throughout the archipelago will be guided by resource and capacity management considerations. No new providers will be onboarded in New Providence during the fiscal year 2024-2025.”

Defending the measures, and seeking to explain the rationale for their implementation, the NHI Authority Board also warned that further cutbacks and restrictions may become necessary. It added: “Since its launch in 2017, the NHI programme has become a Bahamian success story, exceeding expectations and pioneering a transformative approach to healthcare delivery.

“The programme has successfully enrolled over 160,000 Bahamians and residents, and provided them access to essential healthcare services. It has also significantly improved health outcomes nationwide, ultimately contributing to increased life expectancy and reduced healthcare disparities.....

“These changes have been carefully and thoughtfully considered to serve the best interests of all stakeholders. The NHI Authority Board of Directors and executives are committed to responsible governance, which necessitates the implementation of these operational and programme reforms,” it continued.

“Our provider network and the Bahamian public deserve a programme that operates efficiently while maximising resources. As we continuously assess the performance of the NHI Authority programme during the fiscal year, if additional measures become necessary we will communicate them directly to you, our valued stakeholders.”

The NHI Board concluded by pledging that it “will work diligently to recommend diverse and sustainable funding mechanisms to the Government, ensuring the longevity and success of the NHI Authority for future generations of Bahamians”.