Medical Industry Unites On ‘Flawed, Unsustainable’ Nhi


Tribune Business Reporter


Nine healthcare industry bodies yesterday unveiled an alliance that will develop an alternative to National Health Insurance (NHI), which they continued to brand as “seriously flawed and unsustainable”.

The United Healthcare Reform Alliance (UHRA) largely reiterated the previous positions held by the respective medical industry bodies, and promised it would develop “a practical, sustainable plan for universal health coverage” (UHC) in the Bahamas.

The Alliance’s members include the Medical Association of the Bahamas; the Consultant Physicians Staff Association; the Bahamas Association of Physiotherapists; the Bahamas Doctors Union; the Bahamas Association of Medical Technologists; the Bahamas Association of Primary Care Physicians; the Bahamas Psychological Association; the Bahamas Insurance Association; and the Bahamas Insurance Brokers Association.

Dr Sy Pierre, president of the Medical Association of the Bahamas (MAB), told Tribune Business yesterday that the groups came together because they felt there was strength in numbers, and that a unified, single alternative to NHI would gain greater acceptance than the professions each doing their own thing.

“We came together, obviously, because there is strength in numbers,” Dr Pierre said. “You had the physiotherapists doing something, the pharmacists doing something, the nurses doing something, but healthcare requires all of us to work as a team. 

“There are things the insurance industry may need that I may not think about and vice versa, and we need clearly defined pathways with everyone’s input. Once we define our clear pathways, all the Government has to decide is what is a fair remuneration for our services.

“We decided to come together because no one group can speak for everyone and we want to act as a team. When the rubber hits the road, we need to know what is going to happen. When the patient walks in the door on day one we need to know what to do. We have a template that we can present to the Government.  It’s a work in progress and we are really willing to work with the Government.”

Dr Pierre, in unveiling the Alliance, said it continued to oppose NHI as currently structured because it was “seriously flawed and unsustainable for the Bahamas “.

He added: “In addition, we have serious concerns about the significantly defective draft National Health Insurance (NHI) Bill, which was developed without authoritative input from local professionals.

“Our coalition is calling for real, comprehensive healthcare reform utilising its members’ extensive expertise and experience. As the professionals who work in and experience the system on a daily basis, we are in a unique position to understand and propose solutions to the challenges within the current Bahamian healthcare system.”

The UHRA separated UHC from NHI, as the latter is just one financing option to fund the former. It has set out 10 points on UHC that will form the basis for its alternative proposal.

Backing UHC as a concept, the UHRA said it already existed in the Bahamas, but needed to be improved and expanded, with “flaws in the existing system mainly concentrated in the public health sector”.

Its principals state: “The UHRA is of the view that UHC must be affordable, sustainable and bring about minimal disruption to the healthcare system and the economy.”

Reaffirming that the healthcare industry rejects the current NHI model, the UHRA said its design and implementation must not be tied to political agendas and election cycles.

Charging that the Government’s timetable was “unrealistic and inconsistent with international best practice”, the UHRA added: “The UHRA has serious concerns about the draft NHI Bill.

“In particular, we are troubled by the extensive powers of the Minister, the intrusive powers of the proposed NHI Authority, the deficient governance structure of the programme and the potential impact of the legislation on the privacy and protection of personal data of persons. “

Confirming that none of its nine members will sign on to the current NHI plan, the UHRA echoed the Bahamas Insurance Association (BIA) in saying there was no need for the Government’s proposed public health insurer.

“There is no need to establish additional government entities at the expense of taxpayers. The UHRA opposes the duplication of efforts and creation of multiple layers of bureaucracy in the expansion of UHC. The focus must be on patients, not on government red tape or the expansion of the public service,” its principals said.

“The UHRA does not support the creation of a public insurer. Rather, the existing legislative and regulatory frameworks for private health insurers should be enhanced to ensure greater transparency, accountability and efficiency. The Government should maintain its traditional role as regulator and not engage in private enterprise.”

    The primary healthcare phase of National Health Insurance, which was expected to start in April 2016, has been delayed for “around six months or so”, Health Minister, Dr Perry Gomez, told reporters last month. 

Dr Locksley Munroe, president of the Consultant Physicians Staff Association, told Tribune Business yesterday that the Government should look to the NIB roll-out as a template for NHI and how it is to be funded.

“National Insurance started in October 1974. The first payout from NIB came 26 weeks after that,” he said. “If you are trying to fund universal health care you ought not to be speaking about everything at once.

“It has to be a phased approach, otherwise you’re going to end up in the same situation many health systems have found themselves in, where they collapse in two years’ time because you’re trying to keep up with something that was never properly funded.”

    Dr Munroe added: “The registration process should not stop. People should be asked to register. People should be told they are going to have to make their contribution to the NHI fund, and when we start to roll-out the benefits, whether it is 26 or 50 weeks later, you would know that you have credit on your registration card because you would have been paying into the fund.

“If we are already stressed financially, then rolling out everything at once is likely to create even greater financial stress.”


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