Physicians Urged: ‘Target 2o% Of $2bn Health Care Spend’


Tribune Business Reporter


Physicians were yesterday urged to “take over the industry of medicine” and target 20 per cent of the $2 billion spent annually by Bahamians on health care.

Calling on local practitioners to go after the 85 per cent of every $1 spent by Bahamians on health care services in the US, urologist Dr Robin Roberts, said too many physicians were losing business by “abusing” their fee schedule and charging consumers whatever they wanted.

During a debate at at the Medical Association of the Bahamas’ (MAB) 41st annual scientific conference, Dr Roberts said: “We have to recognise that 85 per cent of the Bahamian dollars spent on health care is being spent in the Mayo Clinic  and Cleveland Clinic; that people in Abaco and Freeport don’t want to come to Nassau but go to Florida.

“If we really want to improve the cost of health care and make it lower, then we need to band together as physicians, have partnerships, take over the industry of medicine. If we can get 20 per cent of the $2 billion, we will be well on our our way.”

Dr Roberts argued that physician fee schedules were at the heart of the high cost of health care in the Bahamas.

“I think that our fee schedule is right at the heart of it,” he said. “We abuse it. We can charge how much we want, when we want. I can say without reservation that we abuse the fee schedule.

“We have this because our managed care is unregulated in the Bahamas. In the US, it’s a highly regulated industry. It’s not regulated for us, so when the fee schedule goes up every year, we go up, and when the price goes up, we charge more.”

Dr Roberts further argued that physicians could reduce waste and be more effective in their use of technology. He added that many Bahamians simply do not have the money to pay for their health care.

“People just don’t have the money. If you don’t have the money, you can’t buy insurance or pay out of pocket,” Dr Roberts said.

  In arebuttal to Dr Roberts’ position, Grand Bahama-based Dr. Paul H. Ward, a consultant obstetrician and gynaecologist, said it was not physicians but an aging population, as well as the rising cost of pharmaceutical and medical supplies, that were key the reasons for the high cost of health care in the Bahamas.

“Blaming the pharmacists, the physicians and the insurance companies might actually impede our ability to solve our health care challenges. It may impede our promotion of cost effective health care, and it will be unhelpful in promoting appropriate health care reform,” Dr Ward argued.

He said the fees charged by most Bahamian physicians were “very reasonable”, and that the problem lay in the cost of hospitalisation. Dr Ward also argued that the rising cost of pharmaceuticals and medical devices was also to blame.

“The cost of medicine is always rising. The medical supplies do not mimic the economic principles we see in other industries. Unfortunately, the companies that do medical supplies and devices fix their prices because the Government is going to buy it. There is little incentive to reduce the cost. The cost of technology drives health care costs up,” said Dr Ward.

“It’s not the doctor’s fees. There is the administrative costs and hidden costs driving up prices. We also have to look at our aging population. We have 9 per cent of our population that is over 60. This is going to increase to 18 per cent by 2030.” he added.

“The population over 65 years is going to go from 6 per cent to 12 per cent. This means more complex issues and more utilisation of our public health care system. We have seen an increase in outpatient visits of 4.5 per cent per year compared to a population growth of 1.5 per cent.

“Non-communicable diseases is a big problem. We have a sick population. People just don’t exercise enough. They are not eating  properly, they’re drinking and smoking, and this is why insurance rates are going up.”


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