Big Doctor Fee Cuts ‘Only Way Nhi Can Work’


Tribune Business Editor


The Medical Association of the Bahamas (MAB) president yesterday said “significant” cuts to doctors’ fees were “the only way” to make National Health Insurance (NHI) work, adding: “This is what you get with socialised medicine.”

Dr Sy Pierre said the reduced remuneration offered by the NHI Secretariat should not have shocked MAB members and other physicians, as this was how ObamaCare - and similar healthcare systems in the UK and Canada - operated.

The MAB president said that while this would be NHI’s reality for many Bahamian doctors, it did not necessarily mean that he agreed with it or that it was correct.

Detailing his concerns with the proposed healthcare reforms, Dr Pierre said reduced fees would mean doctors would have to spend less time with patients, which could compromise the quality of care.

And he warned that lower compensation would also exacerbate “the brain drain” that has seen highly-trained Bahamian physicians leave for better-paying prospects abroad, with no one coming back to replace them.

The MAB president also expressed concern about the minimal focus that had been placed on developing an electronic records system to administer NHI, given that this was vital to preventing fraud, waste, mismanagement and other abuses.

“The remuneration is going to be a significant cut,” Dr Pierre confirmed, “but that’s how socialised medicine, socialised healthcare systems, work.

“I don’t know what they expect,” he added of his fellow doctors. “Why would people think socialised medicine would give them the same remuneration as private care? It makes no sense.

“A Government socialised medical system is going to be a system with lower remuneration. I don’t know why it’s such a shock to people. I was not surprised at the remuneration they discussed.”

Tribune Business revealed yesterday how the many primary Bahamian physicians had been left stunned by the “70 per cent across-the-board” fee cut proposed by the NHI scheme, after the rates were revealed to them last week.

They fear that if these rates stand, they will be unable to support significant investments in their practices and cover standard overhead costs, resulting in unprofitability and forced downsizings that are likely to result in job losses.

Dr Pierre, though, reiterated that “the remuneration cut has to be steep” for NHI’s primary care phase to fit within the $100 million budget that has been allocated by the Government.

The scheme, as presently crafted, effectively seeks to compensate doctors for reduced fees/margins by providing them with greater patient volume and a series of set fees.

“The natural incentive will be to pack people in there, or reduce the amount of care and visits,” Dr Pierre said of NHI’s consequences for doctors.

Much will depend on whether the assumptions underpinning the NHI model, namely the likely number of annual patient visits to their primary care physician, holds up.

The MAB chief, dividing Bahamian physicians into three categories, said those who were less successful, and had smaller practices, would be the ones supporting NHI simply because if held out the promise of greater patient numbers for them.

“They’re not doing anything I didn’t expect,” Dr Pierre told Tribune Business of the Government and its NHI Secretariat.

“They’re meeting my expectations. I didn’t expect this to be some panacea where people are going to have great healthcare. That’s not going to happen.”

Reduced healthcare quality, he added, was “a natural phenomena” if doctor fees were cut. “It happens everywhere if you reduce the amount of monies,” Dr Pierre said.

“The remuneration is a significant cut. It has to be to make it [NHI] work in some way or form. That’s just the way it is, unless our governance gets to the point where there are better jobs, more money in the economy, so we’re not as dependent on a socialised healthcare system.”

Dr Pierre argued that NHI’s development was a reflection of the Bahamas’ economic stagnation, and the fact that private health insurance coverage was either being dropped by employers, or was being priced out of reach of many Bahamians.

“The Government doesn’t want to admit it, but NHI is a symptom,” the MAB chief argued. “Say we didn’t have the crime and Immigration issues, and there were more stable, good-paying jobs.

“There would be absolutely no need for NHI, as everyone would be able to afford health insurance. NHI is a reflection of our poor economy.”

Dr Pierre said he did not want to see the Bahamian healthcare system under NHI become a “prescription mill”, as had occurred in the US.

He explained that American physicians he knew were seeing up to 40 patients a day and taking lunch breaks, meaning they had to cram each person into a two-minute interval, give them a prescription and tell them to come back in a few months.

Dr Pierre then expressed concern that NHI wold exacerbate the “brain drain” of talented Bahamian physicians, as had occurred in Jamaica when it implemented its version of socialised medicine.

“We have consultant level, quality physicians who have left the Bahamas, but the bigger question is that we have no one coming back,” the MAB chief told Tribune Business.

“We don’t have quality physicians coming back. That’s the brain drain issue they had in Jamaica, when they moved to a socialised type of healthcare system.”

Dr Pierre said NHI’s introduction would inevitably “shrink” the market for private healthcare and related insurance, and represented a move “into even bigger, larger government” for Bahamians.

Pointing to problems with NHI-type schemes elsewhere, Dr Pierre said doctors in the UK, whose National Health Service (NHS) is widely regarded as a model for many other nations, went on strike earlier this year “because things were so bad”.


OMG 3 years, 3 months ago

Would the Parliarmentarians like a 70 % cut in their salary ?


birdiestrachan 3 years, 3 months ago

Where are the poor sick people in all of this?


Well_mudda_take_sic 3 years, 3 months ago

They are getting sicker by the day as a result of YOUR corrupt PLP government's failed economic policies that have left most of them with very low paying jobs or no job at all. Get a life YOU very sick freak!


MonkeeDoo 3 years, 3 months ago

Definitely if the PLP continue to govern they need to take a haircut on personal emoluments as well as personal inducements. If they do not continue to govern then those serving during this term must be investigated and if found wanting they must be incarcerated according to law. I am tried of people tiefin my freggin taxes.


Islandgirl 3 years, 3 months ago

It is ballsy of this government to try and essentially manhandle some of the most highly educated and trained members of the populace to fulfill their political promises. Imagine spending an additional 12 or more years after high school, studying and sacrificing and all to become a lackey, nay a slave, to an incompetent government. Yes we need good health care, but no, it is absolutely wrong to go about it in this fashion. Can you tell the lawyer his signature on a document is worth no more than fifty cents? If they, the doctors, educated themselves so that they would not only be productive and contributory members to their society but still can have a well earned and decent standard of living, who are these crooks, thieves and disgraces in parliament to determine otherwise? Why not better educate the population so that they too can be productive and be able to afford better health care, by eating well, exercising, being prudent in reproduction? Make the healthier foods affordable? Work to make their own way so that they are not so dependent upon the government? These are the same people who introduced the disease of gambling against the will of the voters and made it legal for racketeers to pull in millions of dollars daily and yet they are doing this very nasty deed of punishing those who went the right way about educating themselves to legitimately earn a good living. They need to be removed and this ridiculous shit disbanded.


Economist 3 years, 3 months ago

NHI is a nightmare from beginning to end,

The doctors will have to rebel or they will be forced to do it.

Notice that Minnis has said nothing. He has made no reasonable argument against NHI or come up with a better way to do it.

He should be the first to get the cut.


Ironvelvet 3 years, 3 months ago

I am a young Bahamian physician studying abroad and near completion of my training, nearly 18 years after high school.

I love my country and want to come home. I am of the few who has been trying to convince my fellow Bahamian young physicians of various specialties to come home and help to start residencies/fellowships in addition to practicing at home so that we can end the brain drain and end the inability to educate our own people. Many of our Bahamian physicians are leaders in their respective specialties abroad. I would love to see us start our own medical/surgical journal where the world pays attention to what's going on in the Bahamas medically as Cuba and Jamaica have established themselves.

Alas, many of us are paying close attention to the handling of NHI. This 70% reduction in salary will only serve as the nail in the coffin for those of us considering whether or not to come home.

Yes, patients/our people are the priority, but many of have exorbitant student loans and also need the same green paper that all of us need in order to house, clothe, and feed our families.

I urge the government to be cognizant of the fact that the current group of consultants are aging and will be retiring soon. There will be a changing of the guard on the medical front in a few short years, how will our dear Bahamaland fare? Will Bahamians be forced to go to Jamaica, Cuba, or the US and the like for tertiary care? Least I remind everyone we already do that, but it will increase with the current climate of what NHI discussion.


Alex_Charles 3 years, 3 months ago

Bro, sorry to tell you but coming home will not end the brain drain and in many cases, depending on your discipline, it's utterly asinine to do so and will only hurt your career. Maybe in your case it will benefit but I know of person who wentto Ivy League schools only to come home and work in a shoe store. Thankfully they went back to the US/Canada and got employment in their fields.

If you want to end the brain drain then run for office and make the change OR stay away and raise the money then come home. Anything outside of Finance, Healthcare, Law or Engineering (debatable) may be damn near financial suicide for someone without the proper connections and family pull.

Brain drains are ended by policies and effective planning and governance. what this administration is doing will only add to the push factors that lead the educated to leave.


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