By NATARIO McKENZIE
Tribune Business Reporter
MEDICAL Association of The Bahamas (MAB) President Dr Sy Pierre says that his organisation is not opposed to any physician or group of physicians seeking to form an Independent Provider Association (IPA), stressing however that IPA “should not be mandatory”.
He also noted that MAB members are concerned over the potential impact on Bahamian physicians if the private, for-profit healthcare facilities form a virtual monopoly - by way of an IPA - on the provision of private and possibly public healthcare.
Dr Pierre told Tribune Business yesterday: “The Medical Association’s position is that any physician or group of physicians that want to form an IPA, they should have that right to form that. However to say that we need it or mandate an IPA to negotiate with the Government on behalf of all physicians then I have a problem with that. As physicians I think obviously everyone want to maximise their earning ability but as physicians our primary concern should be our patients, being the best doctors we can be and getting fair remuneration for our services.
“If someone wants to be an entrepreneur and go into other things and form an IPA that’s fine, but for a large majority of us that is not what we are here to do. We are here to provide a service and get fair pay for that service.”
An IPA would negotiate insurance contracts with both the Government’s National Health Insurance (NHI) Authority and private sector providers on behalf of its members, allowing those doctors to focus on the quality of patient care and the latter’s experience, as opposed to managing costs and administrative issues. “The IPA is fine but I don’t think it should be mandated that the IPA is the negotiator for contracts for the providers under national health insurance. There is just too much room for graft, duplication of services and all the other things that go on,” said Dr Pierre. The MAB is the largest and only officially recognised association of physicians in the country.
Dr Pierre told Tribune Business that he had been effectively forced to address the IPA issue publicly after it was reported that the Trade Union Congress (TUC) and the Bahamas Independent Provider Association (BIPA) had entered into a partnership with major healthcare providers or stakeholders to advance NHI discussions. “The statement was made that the IPA had the majority of physicians signed on to it. I found this to be deceptive especially since I had met with a group which had proposed this and I made it clear that the MAB could not sign on to it. The MAB did not want it, the executive did not want it and I did not want it,” said Dr Pierre.
Dr Conville Brown recently told The Tribune that eight organisations have signed on to a proposed Independent Provider Association. Dr Brown said of the 11 major organisations invited, eight signed on to the initiative on Friday, July 8. These include the Consultant Physicians Staff Associations in Nassau and Freeport; the Grand Bahama Medical & Dental Association; Care Bahamas; Physicians Alliance Ltd; Doctors Hospital; The Sunrise Medical Centre-Hospital Complex and The Medical Pavilion Bahamas. He noted that the Medical Association of the Bahamas, the Bahamas Association of Primary Care Physicians and the Bahamas Doctors Union declined.
“An audience was sought with Prime Minister Perry Christie to inform of our group’s desire to have said model considered as a possible facilitator of implementation of National Health Insurance.,” Dr Brown said. “The prime minister was provided with the signatory list on Saturday, July 9, 2016. He was also advised that of the major physician groups, three had declined to sign on at that stage.”
Dr Brown added that it was always proposed that BIPA be a 100 per cent Bahamian-owned company incorporated in the Bahamas as a non-profit organisation. He added that BIPA would be able to represent all stakeholders in healthcare, including physicians, unions, insurance companies, nursing, pharmacists, etc, and indeed any special interest groups in relation to healthcare provision.
In a statement responding to Dr Brown yesterday, Dr Pierre said that it was “interesting and possibly disturbing” if a meeting with the Prime Minister had actually taken place, noting that the Government has specifically set-up the office of the National Health Secretariat to deal with all matters NHI. “Is Dr Brown saying that his group has special privilege, able to bypass the normal processes and access the Prime Minister’s office? Also, if BIPA is an established or possibly significant stakeholder, how is it that they were not invited to be a part of the Universal Healthcare Advisory Council established by the National Health Insurance Secretariat’s office to address stakeholder issues?”
Dr Pierre continued: “Again, as MAB President the question must be asked - in the public’s interest - are there conflicts of interest with the ownership (possibly including high ranking members of government) of private facilities being on the executive management team of an IPA that wants to negotiate directly with the government for the management of millions of dollars in public funds?
“Also, MAB members are concerned that if the private, for-profit healthcare facilities form a virtual monopoly (by way of an IPA) on the provision of private and possibly public healthcare, what is the possible implication for Bahamian physicians. Are our highly-trained and skilled physicians to be relegated to being employed serfs of these facilities? What will happen in the future when young Bahamian physicians look to come home and there are no opportunities for advancement?”