The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A leading private sector yesterday said he “can’t see” National Health Insurance (NHI) launching by the January 1 target date, even though the Government reiterated its determination to roll the scheme out on schedule.

Edison Sumner, the Bahamas Chamber of Commerce and Employers Confederation’s (BCCEC) chief executive, told Tribune Business that the proposed NHI start was “unrealistic” because there were too many “unknowns” surrounding the scheme, not least the services it will cover and the likely cost.

However, Tribune Business sources in the medical profession confirmed that the Government yesterday emphasised its intention to still begin NHI registration from New Year’s Day 2016.

Medical Association of the Bahamas (MAB) members met with government officials over NHI yesterday, at a meeting that was chaired by Dr Bernard Nottage, minister of national security, rather than his health counterpart, Dr Perry Gomez.

While reiterating the Christie administration’s stance on the January 1 start date, Tribune Business was told that government officials present appeared to have “softened” their position on both NHI’s patient care model and the compensation that will be paid to private physicians.

“They have softened their stance on the medical home, and are still looking to roll out registration in January. They are also going to negotiate what they are going to pay per visit with the MAB,” one source, speaking on condition of anonymity, told Tribune Business.

The MAB had previously expressed concern over the Patient Centre Medical Home (PCMH) model that NHI is striving to create in the Bahamas.

It added that this was a relatively new model, and its benefits in terms of quality, patient experience and other indicators was “largely unknown”.

“There is currently no evidence to support the development of PCMH in the Bahamas, and the MAB proposes that pilot projects should be conducted to validate their use,” the letter to the Prime Minister said. “The implementation of new health care services must be culturally relevant, and must take into consideration the geographic distribution of our islands.”

The MAB also expressed fears over NHI’s $200 per head ‘capitation’ payment system, which bundles payments to physicians together. This, the MAB said, would require Bahamian physicians to manage a network of healthcare providers, while also being responsible for monitoring treatment quality and patient use.

“The essence of capitation is a shift in financial risk from insurers to providers. As previously mentioned, one of the components of quality is the separation of financial and clinical decisions,” the MAB told the Prime Minister.

“Therefore, high quality care must allow for financially-neutral clinical decision making. The MAB strongly objects to the current model as proposed, as we believe that it will force us into the administration of cost rather than the delivery of care.”

Tribune Business was told that while Sanigest’s president, James A. Cercone, was present at yesterday’s meeting, his wife, Etoile Pinder, was not after she branded Bahamian healthcare providers as “morons and money grubbing asses” via a posting to her Facebook page.

Mr Sumner, meanwhile, expressed scepticism that NHI would be ready for its proposed January 1 launch.

He disclosed that the Chamber intended to hold an NHI symposium within the next two weeks to allow various stakeholders - the private and public sectors, insurance industry, MAB, employers and labour organisations to give their views on the scheme and healthcare reform.

Following that event, Mr Sumner said the BCCEC was also eyeing an “independent survey” on the Bahamas’ readiness for the NHI scheme as currently proposed.

“It’s necessary for us to do this before the end of the year if they do have the intention of launching it as planned for January 1, which at this stage we think is unrealistic,” Mr Sumner told Tribune Business.

“We can’t see it launching by then because there are a number of issues outstanding based on the information we have.

“I fully expect to engage with the Government before the end of December and talk about their readiness for January 2016.”

Mr Sumner said the Chamber and its NHI review committee were set to meet with Peter Deveaux-Isaacs, the permanent secretary in charge of the scheme’s implementation, this week.

He told Tribune Business that his assessment of the Government’s readiness was “based on the information we have, and more so the information we don’t have.

“We can’t see it being ready for launch in January even if it’s just the registration process,” Mr Sumner said. “We thought by now they’d have run some pilots on how it’s going to look, but we’ve not seen that.

“We would also have thought information would come to us for consideration and passing on to our members. That has not happened yet.”

The Government’s NHI plan is supposed to be kickstarted by a three-month registration process, which aims to register 85 per cent of Bahamians and legal residents by April 1.

The second stage is to allow Bahamians to select their primary care provider of choice, coupled with the introduction of catastrophic coverage. Then will come the Vital Benefits Package - the basic level of health services to be covered under NHI.

The January 1 registration start-date, though, is some three months behind the original Sanigest plan’s ‘road map’ for a successful 2016 launch. It recommended that this should have occurred by October 2015.

Mr Sumner said the Chamber and private sector wanted to “feel more engaged in the process than we have been”, with regular updates and information provided by the Government’s NHI team so it could advise employers.

“There are still a number of unknowns, and we don’t want to operate from a place of ignorance and lack of information, but want to feel comfortable that we can make recommendations to our members,” Mr Sumner told Tribune Business.