The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The National Health Insurance (NHI) Secretariat’s assertion that 70 per cent of doctors are willing to accept its terms and sign on to provide primary care was describe as “a stretch” yesterday by a senior physician.

Dr Duane Sands, the former FNM senator, told Tribune Business that he was hearing “quite the opposite” to the optimistic picture being painted by NHI project manager, Dr Delon Brennen, when it came to physician ‘buy in’.

Dr Brennen, in an NHI press conference on Wednesday, said doctors who attended the briefing sessions on New Providence, Grand Bahama and Abaco last week had responded “very positively” to the scheme’s structure and compensation rates.

“In our exit surveys, 70 per cent of them have responded to say that not only are they accepting of the fee structure, but they’re willing to sign up and be a part of NHI Bahamas as we go forward,” he added.

Dr Sands, though, suggested yesterday that the ‘70 per cent’ figure quoted by Dr Brennen was “a sampling error”, and questioned what formed the basis of this calculation.

“I’m hearing information that is quite the opposite to that,” he told Tribune Business. “It’s a stretch to come to that conclusion. It’s certainly inconsistent with the views I have heard in the very large physician groups.”

Dr Sands questioned whether the ‘70 per cent’ figure was based on the number of doctors who attended last week’s briefing, or the wider physician community.

He also queried whether it included just primary care providers, the doctors who will be responsible for rolling out the $100 million ‘phase two’ primary care stage for NHI, or all doctors.

“It’s difficult to ascribe any significance to it,” Dr Sands added of the figures quoted by Dr Brennen.

Another doctor, speaking on condition of anonymity, described the percentage quoted by the NHI project manager as “laughable”.

Among those who attended one of the two New Providence briefing sessions, the doctor told this newspaper: “The evaluation forms they gave out at that meeting, no one completed them and handed them in.

“There’s still lots of unanswered questions, obviously not just the fee schedule but the contracts, what’s in the contract, how and when we will get paid. There’s no insurance been created by the public and private insurers for NHI yet.”

The NHI primary care phase cannot be rolled out without the support, participation and ‘buy in’ from primary care doctors, especially those in the private sector, who the Government is hoping will take extra patients and relieve the burden on the public healthcare system.

Another doctor, speaking on condition of anonymity, questioned whether the NHI Secretariat had calculated the “minimum” number of doctors needed to launch the primary care phase.

“That’s their choke point right there,” the doctor said. “They need to admit they’re not going to get enough doctors. I don’t know anyone who’s going to sign up apart from the junior doctors.

“What’s going to happen is they’re going to force the Government doctors to enroll in the system.”

The NHI Secretariat rolled out Dr Charles Clarke, head of the Bahamas Doctors Union (BDU), to endorse the scheme at its press conference and give the impression that doctors were behind it.

Physician sources suggested that this was misleading, though, given that the BDU largely represents the junior doctors at Princess Margaret Hospital (PMH) and within the Government health system - not the majority of those who will be required to provide primary healthcare under NHI.

In addition, Tribune Business can reveal that while around 60 physicians in total attended the two Nassau briefings, just one turned up for the Abaco event.

Dr Sands said the views of the primary care physicians group and bodies such as the Consultant Physicians Staff Association (CPSA) would be more important in relation to NHI.

“You’re going to need a certain number of physicians for people to perceive they have improved access to care,” Dr Sands told Tribune Business. “That number is anyone’s guess, but it’s certainly going to be more than a handful.”

He questioned whether the NHI Secretariat had given any thought to the fact that there were many Family Island communities that did not have ready access to doctors at all apart from the Government health system.

And the former FNM senator added that the Christmas and New Year holiday season were now set to intervene in terms of completing the NHI scheme and answering all the unresolved questions.

“We move into the New Year with very little of the management [for NHI] in place,” he told Tribune Business. “No one knows what the plan entails. There is no document anywhere to say this is what NHI includes - coverage, benefits, who’s paying for it...

“Consider me not only cynical, but sceptical and cynical. We’ll see. Don’t hold your breath.”