By AVA TURNQUEST
Tribune Chief Reporter
DR SY Pierre, president of the Bahamas Medical Association, yesterday criticised the National Health Insurance Secretariat as a public relations campaign dedicated to spinning a narrative of support for the scheme despite glaring industry concerns.
Dr Pierre took the Secretariat to task over its recent narrative of doctor support for the proposed fee structure, and willingness to sign-up as care providers. He underscored that there was likely a political agenda to launch the initiative before the 2017 general election, and that this has contributed to the vague reports emanating from the administrative body.
At a press conference on Wednesday, NHI Project Manager Dr Delon Brennen said almost 70 per cent of physicians who attended last week’s briefing sessions had indicated they would accept its proposed fee structure and sign-up as care providers.
Noting that the percentage was taken from a total of 40 physicians, Dr Pierre questioned why the Secretariat would promulgate such a “meaningless statistic” given its claim that the fee structure had not been finalised, and would most likely change following collaboration from stakeholders.
“It’s statistically insignificant, it’s a public relations campaign,” Dr Pierre said, “giving the idea that it is ready and workable, but it’s far from that. The public is not getting all the information.”
“Obviously there’s possibly a political agenda, I’m sure government wants to get this done before election. Why wouldn’t they? It’s a programme, it’s socialised medicine. NHI is a symptom of an economy that lacks diversity. If crime was lower, if immigration wasn’t a problem, if the education system was good, what this is saying is that our economy is so bad that most people can’t afford insurance.
“It’s a reflection of how bad the economy is, but they’re [Secretariat] motive is to say yes, this is their agenda, to say yes this is something that is doable at the end of the day.”
On Wednesday, the Secretariat announced that it would begin the registration of primary care physicians in January; a critical milestone in the NHI timeline, upon which hinges the success of the entire scheme.
However, NHI officials were tight-lipped over the minimum number of primary care providers the scheme will need before it can move to the next phase. Yesterday, Dr Pierre argued that the figure was a basic algebraic equation that could be easily calculated given the amount of money spent on consultants for the scheme.
The Secretariat has maintained that once the registration process for physicians is “well underway”, phase two or public enrolment to the scheme will begin. Primary care services, phase three, was said to follow “closely thereafter”; however, no deadlines or dated schedules were given for the implementation track in 2017.
Speaking to general concerns from the medical community, Dr Pierre said: “They don’t even have software set up for electronic health records, and without that it’s pointless. If you can’t access those records you don’t know what’s going on, you can’t monitor or manage care. And no one has said anything about the software.”
“We’re not doing specialty care but if you start doing more pap smears, more breast exams, what are you going to tell people? Oh we can’t do the surgery, but you have cancer. We’re not doctors, we’re medical monitors. NHI doesn’t cover it so you have to go right back and start over from the public ward.”
He said: “When you see the commercials, it’s a spin, and they have time to spin now.”
Dr Brennen confirmed that 40 physicians participated in exit surveys at the New Providence provider sessions on December 6-7, and two other meetings held on Grand Bahama and Abaco on December 8.
The reimbursement options shared at those meetings were also revealed at the NHI press briefing.
The three options are: fee-for-service, where services will be reimbursed using a simplified fee schedule; capitation model, which provides reimbursement for each individual who signs up for care with a physician; and maternity care or infant care bundles, where reimbursement will be given for a package of pre-determined essential services for pregnant women and infants up to two years old. The third option is also available to physicians who are on the other models.
Doctors attending the provider sessions told Tribune Business that the NHI architects were trying to impose a “70 per cent across-the-board” fee cut, and squeeze everything into the $100 million budget allocated by the government.
Dr Pierre said: “We’re still in a recession, conditions are changing. A lot of physicians are coming out as general practitioners. NHI patients don’t have to comprise all their patients, but with NHI coming, why would I go and pay to a private insurer?
“That’s what they don’t want to say, this is obviously going to be a challenge to the private insurance market with jobs. All of those things are going to come out.
“They’re not being completely honest with the public. (Speaking to the maternity care bundle) those nine visits don’t include delivery of the baby. You can go to a private doctor for nine visits but if you don’t have money for a private room and delivery then you’re going to be at the public ward.
Dr Pierre said: “Your doctor may volunteer to still deliver the baby, but that needs to be made clear, because it will turn into oh the greedy doctor won’t deliver.
“It needs to be very clear that’s not included,” he added.