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Nhi Fee Slash May Undermine Health Quality

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A prominent physician has warned that the massive cuts in doctors’ fees proposed by the National Health Insurance (NHI) scheme could compromise healthcare quality for many Bahamians.

Dr Duane Sands, the ex-FNM senator, told Tribune Business that the “70 per cent across-the-board” fee cuts being proposed by the Government (see other article on Page 1B) threatened to “drive patients” to less-successful doctors with inferior practice infrastructure.

“Here we go again,” he told this newspaper. “We basically will have a scenario that drives the NHI patient to providers with less busy or successful practices. It may mean we are driving patients to inferior care.

“It sounds as if they’re saying this is what we’re going to pay the physicians, and they can like it or lump it. Take it or leave it.”

Dr Sands said the promise of an expanded patient population would prove attractive to less capable and successful physicians, who had invested less in staffing, equipment and other infrastructure, and were struggling to survive.

While they were more likely to sign up for NHI, Dr Sands said the reduced fees and other government impositions would act as a disincentive for better physicians and those with larger staffs and overheads, who may be forced to downsize.

“The important thing is that better physicians will either shut down or leave the jurisdiction,” he warned of NHI and its fees. “It’s a heck of a gamble, and seems intended as constructed to appeal to the masses of individuals who cannot afford private care.

“It will help some people, but will not help quite a few. Some of the better physicians will say they cannot afford to provide quality care at this price, so they will say: ‘Thanks very much, I’m not going to participate’ or cut down on quality.”

Turning to the specific fees, Dr Sands said it seemed as if the Government and its NHI Secretariat were trying to give Bahamians the impression that private practitioners were “price gouging” or “over charging” for the services they provided.

He added that it seemed as if the NHI plan was also based on doctors compensating for reduced fees/profit margins through increased patient volumes.

“The assumption implicit in that is physicians are overcharging,” Dr Sands told Tribune Business. “They seem to believe that on the basis of volume you can make up by having some type of factory production line of patient care.

“I suppose the reason why people charge what they charge is because that is what it takes to provide the service - ambience, staff, equipment, and added time with the patient and care.

“I can speak to the fact that consultation is not a profit centre in my practice; I barely break even.”

Dr Sands expressed doubt that the Medical Association of the Bahamas (MAB) and private physicians would be able to negotiate better NHI fees, unless last week’s meetings were “a first pass” designed to test the waters, with the intention of coming back with slightly higher numbers.

Explaining how current fees worked, Dr Sands said all medical services provided in the Bahamas had their own specific codes and terminology. Each is given “a relative unit”, and all units have their own specific costs attached.

“The MAB determined a number of years ago that the relative value units be reimbursed on a scale of $9-$11 per relative value unit,” Dr Sands told Tribune Business.

“Above that criteria is considered excessive billing. You’re now talking $3-$4 per relative value unit [with NHI]. In the absence of some kind of subsidy to cover garbage disposal, records maintenance and medical management, it is going to be impossible to safely practice medicine and pay malpractice cover, your expenses at that level, unless you start from the premise that physicians are gouging the public.

“That is certainly not true. The MAB fee structure has not changed in a decade.”

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