The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

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”.