The Tribune

BY ANNELIA NIXON

Tribune Business Reporter

anixon@tribunemedia.net

A NATIONAL Health Insurance (NHI) provider warned that the scheme is headed for “a very dystopian future” despite a budget increase of some $24.5m allocated for the National Health Insurance Authority (NHIA) if the government continues with payment delays, communication breakdowns and financial disputes with providers.

Criticisms from Dr Denotrah Archer-Cartwright, a leading voice among NHI providers, comes as a response to Health and Wellness Minister Michael Darville’s Budget Communication, in which he announced a $72.2 million allocation for the NHIA, representing an increase of approximately $24.5 million over the previous fiscal year.

Dr Archer-Cartwright said the increased funding offered little reassurance to physicians who remain owed money for services already rendered and who continue to face what she described as an increasingly strained relationship with the NHIA.

“What they keep doing is they are meeting with the MAB,” she said, referring to the Medical Association of The Bahamas. “The MAB president is on the board, which is already a conflict of interest.

“The majority of the doctors are in our group. We have not been approached about meeting with them. They keep putting off and saying they’ll get back to us about a meeting. But they don’t seem to have an interest in speaking with us as a group.”

The dispute highlights growing tensions between NHI providers and the government over the future direction of the programme. Physicians have repeatedly raised concerns in recent years over delayed reimbursements, administrative burdens and funding shortfalls, issues that have surfaced publicly on several occasions as the government sought to broaden healthcare access through NHI.

Dr Archer-Cartwright argued that providers are being denied the opportunity to collectively negotiate or discuss their concerns with the Ministry of Health.

“And what I said to Dr Darville- because I just happened to see him, actually, so strange- is what is the issue, because when they want to meet us as a group, they call us in as medical directors,” she said. “But when we say we want to meet with them as a group, it becomes a problem. ‘Oh, you guys are individual contractors.’ So, what is the issue about meeting with us, our group, to discuss the problems that we're all having?

“The reason why we want to meet as a group is because as individuals, a lot of physicians feel intimidated. They get kind of railroaded. They have an entire legal team, and you’re sitting there by yourself. So, it’s an uneven partnership at the moment.”

Her strongest criticism was directed at the government’s plans to expand NHI services despite what she described as unresolved operational and financial problems.

During his budget presentation, Dr Darville said the additional funding would strengthen the NHI Prescription Drug Fund, improve access pathways, expand coverage and support the integration of additional public healthcare facilities and providers into the programme.

He also acknowledged payment delays experienced by some providers during the government’s previous term in office.

“I will be the first to admit that our last term in office we experienced some delays in payment to some NHI providers, one who I met early this morning in the food store,” Dr Darville said. “These delays were due to a number of reasons that I will not go into during this budget debate. But I am pleased to report to her and other providers across the country, after close collaboration with the Ministry of Finance, additional funding for NHI was allocated in this year’s budget to mitigate this vexing challenge and to compensate for the natural growth of the programme and to ensure that we are able to bring on additional public healthcare facilities as well as public and private sector providers.”

He added that additional funding had been secured through collaboration with the Ministry of Finance to address the issue and support the programme’s growth. However, Dr Archer-Cartwright questioned the logic of expanding services before settling existing obligations.

“He said they’re now going to be covering NHI drugs, so that’s an expansion of their responsibilities,” she said. “They’re going to be expanding to the government clinics. Why would you need to do that?

“The doctors you have now, you’re not paying them on time. Whatever the issue is in the background, they won’t tell us.

“They continue to expand. They want to add some catastrophic care, they want to add the pharmacy aspect of it. But you’re not dealing with what you have in front of you.”

She also questioned how the government intends to finance new services while simultaneously addressing arrears owed to providers.

“The questions that you guys need to ask him is, what is the deficit owed to the physicians each month, and how much of that [budget] money is going to that,” she said.

“If you’re expanding the programme, which means that more people will be coming on, how much money is allocated to that?”

Dr Archer-Cartwright further alleged that physicians are being forced to absorb costs associated with operating the programme through fees deducted from payments without their consent.

“Right now we have an issue where they are charging us without our consent the money that they’re owed to us,” she said.

“They’re taking fees out, fees that we did not agree to to sustain the NHI programme. Doctors are now paying for the programme.”

She added that providers continue to face changing policies, reconciliation disputes and reimbursement challenges that are placing financial pressure on medical practices. Despite her criticism, Dr Archer-Cartwright said physicians remain supportive of NHI’s broader objective of expanding healthcare access for Bahamians.

“We want all Bahamians to get access to health care,” she said. “That is the priority.

“But it has to be done in a manner where physicians are not in debt, or so burdened by the system that they want to quit.”

She argued that the government’s latest budget presentation lacked sufficient detail on how much of the increased allocation would be directed toward clearing provider arrears and ensuring future sustainability.

“We need more clarity,” she said. “That $72 million can encompass a lot of things in there.

“I do not see room for the proper growth. We’re going to be in the same spot again if they don’t allocate enough funds for this growth.

“There’s so many things that they’re just kind of glossing over with this general idea of more money. But are we fixing the issues?”

Dr Darville described the nearly $468.5 million allocated to the Ministry of Health and Wellness under the 2026-2027 Budget as the largest healthcare allocation in Bahamian history, saying it demonstrates the government’s commitment to healthcare reform throughout the archipelago.