The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The National Health Insurance (NHI) scheme is set to impose “caps and limits” on a portion of the care benefits received by 160,000 Bahamians as part of further “cost containment measures”.

The Government healthcare plan’s governing authority, in a notice sent to the scheme’s providers and which has been obtained by Tribune Business, said the restrictions to laboratory benefits will be introduced in October 2024 and help to “better manage.... escalating costs”.

The notice also revealed that limitations will be maintained on the size of NHI’s care network, and the number of doctors, laboratories and other medical facilities offering services to patients enrolled in the scheme, with no new providers set to be added on New Providence before the 2024-2025 fiscal year ends next June 30.

Payments for laboratory services will now be made at month’s end on the 30th, instead of the 15th, from September onwards while the 90-day wait that all new patients - apart from expectant and new mothers, as well as infants - must endure before they can join NHI remains in place.

Dr Michael Darville, minister of health and wellness, in a messaged reply to Tribune Business inquiries confirmed that the notice from the NHI Authority was genuine and defended the measures as “prudent” to “ensure the continued sustainability and effectiveness” of the scheme.

But Dr Duane Sands, the Free National Movement (FNM) chairman and one of his predecessors as health minister, told this newspaper he is “not in the slightest bit surprised” that the Government and NHI have had to seek further ways to contain healthcare costs and added: “I cannot see how they could not have put the brakes on this runaway train.” (see other article on Page 1B)

The NHI Authority Board’s notice, dated August 12, 2024, was said to have only reached some of the scheme’s medical providers yesterday. One, speaking on condition of anonymity, said: “This is breaking news. This is hot off the press. The phones are lighting up. Everyone is talking about it.”

The notice 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.”

Confirming other more minor adjustments, as well as the continuing 90-day wait before most new patient applicants are admitted to NHI, the NHI Authority Board added: “As of September 2024, the payment schedule for laboratory reimbursements will be adjusted to the 30th of each month. Capitation and bundled payments will continue to be reimbursed on the 15th of each month....

“The 90-day enrollment timeline for new beneficiaries will remain in place, except for maternity and infant beneficiaries, who will receive the previous standard processing timelines.” The changes, especially the laboratory benefits “caps and limits”, could affect up to 40 percent or four out of every ten Bahamians based on a 400,000-strong population.

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”.

Translated, the notice appears to warning Bahamians - and especially NHI beneficiaries - that there is little choice but to cap and restrict some of the care benefits they enjoy because the healthcare scheme’s costs are exceeding the multi-million Budget financing received from the Government.

The NHI Authority was allocated $46.2m for the 2024-2025 fiscal year in the Government’s now-approved May Budget, which is a sum equal to what was granted in the prior year. Almost 70 percent, or $32.273m, of the funding granted for the 2023-2024 fiscal year was used during the first nine months to end-March with the NHI allocation for the next two fiscal years presently unchanged at the same $46.2m. 

However, questions were yesterday being asked as to whether the $46.2m allocation is still sufficient and if NHI is under-funded. One source, speaking on condition of anonymity, challenged why patients and providers were only being alerted to the possibility of cut backs and restrictions now when this would likely have been known from when the Budget was unveiled and passed.

Arguing that the NHI Authority Board’s letter was effectively saying the scheme is “not properly funded”, hence the need for “caps and limits”, they added: “Why has it not sufficient;y been funded to cover expenditure? NHI should be in a position where it’s expanding benefits, not cutting back.

“They’re trying to manage money they don’t have. The Budget is baked. Why wasn’t that revealed when NHI was discussed during the Budget? They cannot be talking about money in the second week of August.

“Was the allocation insufficient? You cannot say that in the second month of the Budget. Why wasn’t that mentioned in the context of the Budget by the minister responsible for health? When was this known, and why not communicate this position with the Budget exercise?”

Dr Darville, in reply, told Tribune Business: “As noted in the August 14th memo, the NHI programme funded by the Government of The Bahamas has achieved remarkable success and significant growth over the last seven years, enrolling over 160,000-plus Bahamians while ensuring access to quality, affordable healthcare across the archipelago.

“As a government agency, NHI is committed to ensuring fiscal responsibility and good governance. In light of our ongoing review of programme utilisation and resource management, we have introduced prudent measures to ensure the continued sustainability and effectiveness of the programme.”