The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A former health minister yesterday backed the IMF’s call for the Public Hospitals Authority (PHA) to impose patient fees on those “with the ability to pay” and “double” its present $20m annual revenues.

Dr Duane Sands, now the Free National Movement’s (FNM) chairman, told Tribune Business that this recommendation can be implemented “without hardship to any patient” as it was simply calling for the public healthcare system to collect due revenues from those with insurance and the means to pay.

Emphasising that those who genuinely cannot afford to pay will not be required to do so, he added that “lack of political will and push back” has dissuaded successive PLP and FNM administrations from introducing patient fees because of “the boogeyman that it will somehow make people suffer”.

In contrast, Dr Sands agreed that introducing a proper fee schedule, and levying and collecting these charges, would give the PHA and the three facilities it operates - Princess Margaret Hospital (PMH), Freeport’s Rand Memorial Hospital, and the Sandilands Rehabilitation Centre - legitimate income due to them by right that can then be used to upgrade infrastructure plus improve the quality of care and outcomes.

Pointing out that it would also reduce the burden on Bahamian taxpayers, who are presently required to provide around $225m in annual subsidies to finance the PHA, the former minister added that the services PMH is providing free-of-charge are currently incurring fees ranging from hundreds to thousands of dollars a day just down the road at Doctors Hospital.

“I think it’s important to understand the distinction that is being made that this is identified revenue that is lost by the PHA but which can be captured in other facilities,” Dr Sands said of the suggestion contained in the IMF’s Article IV statement. “All this revenue, legitimate revenue, which in no way impacts the patient, is lost.

“When you look at the PHA’s ability to meet its expenses, to maintain the facilities and so on and so forth, it is unable to do so year in, year out. Without any hardship to any patient, it can be put in a significantly better position and ease the burden on the public purse.

“Bear in mind the Government of The Bahamas already spends tens of millions for healthcare premiums for a number of sub-sets of civil servants. There is also 30 percent or more of the population covered by private insurance. Unfortunately, the PHA is not well-positioned to take advantage of that potential revenue.”

Asked whether he agreed with the IMF’s recommendation, Dr Sands replied: “I think it’s win-win situation. Yes, I do. They are not calling for hardship being imposed on people that don’t have the ability to pay. They’re simply saying the PHA should receive the revenue that it’s entitled to. That’s a simple legislative, programmatic or policy fix.”

Dr Sands said reforms to legislation stipulating that mother and child care are free would be necessary, adjusting them for ability to pay. As an example, he said neo-natal intensive care services offered at PMH are capped at a daily rate he believes is $300 even for persons who possess private insurance and the means to cover the full costs.

“We know every year the PHA has been cash strapped and unable to meet its expenses,” the FNM chairman said. “This ought to be something we agree on as a country - that the huge spend in the private sector on healthcare, some of that comes to the benefit of the major, premier public healthcare facility in order for it to deliver better quality of care, get better staffing.

“In my view, it’s so simple. I’m surprised it hasn’t been done. It’s a lack of political will and push back. We have created this issue, and created a boogeyman that this somehow will make people suffer. That’s the furthest thing from the truth. We will always have people who cannot afford to pay out-of-pocket and they ought not to pay.

“But there are those that have the means, and often times the money is paid by the Government of The Bahamas so they can have private insurance. We have not found a way for them to use that private insurance for the benefit of public healthcare facilities.”

Asked to quantify how much revenue is missed by the PHA, Dr Sands replied: “Given the fact that the PHA’s annual revenue is less than $20m per year, it is fair to say that revisions to the fee schedule in order to take advantage of this type of opportunity can double the PHA’s revenue, and I think that is a conservative estimate. I think it is probably more than that.

“If you look at the number of insured persons in the country, and the impact on healthcare, the PHA - the Rand, PMH, Sandilands - ought to be benefiting considerably more to make the public healthcare facilities better, more efficient and give better outcomes. That’s a necessary step to improving public confidence in our healthcare facilities.” To effect this, a proper accounting and billing system will be needed.