The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Opposition’s deputy leader yesterday expressed concerns that National Health Insurance’s (NHI) proposed payment methods could drive high-qualified doctors to leave the Bahamas.

K P Turnquest told Tribune Business that the capitation system, which would pay doctors a set annual fee per patient, may drive some to seek higher returns abroad if their earnings are effectively “capped”.

He added that the issue was one of numerous concerns that the Government still has to address, saying it was “not unexpected” that Ministers and officials were now talking about postponing the April 2016 start for NHI’s $100 million primary care phase.

“The reality is that the Government does not have itself in a position where it is able to roll it out,” Mr Turnquest told Tribune Business. ‘There are so many issues here that to push it through in six weeks is just untenable.”

Both Dr Perry Gomez, minister of health, and Dr Delon Brennen, the NHI project manager, have now publicly floated the idea that NHI’s primary care phase may be delayed beyond the targeted April start.

Healthcare industry stakeholders have all expressed concerns and reservations over the NHI scheme’s design as is, and their participation and ‘buy in’ - especially by private doctors - is crucial to a successful implementation.

“They’ve still not been able to cajole the private doctors into participating, and not been able to satisfy the insurance industry that it will not cause a total collapse of the sector,” Mr Turnquest told Tribune Business.

“They can’t tell us what this is going to cost. All the operational issues highlighted by the doctors still pertain. What is the cost of this programme and who is going to pay for it? Nothing is free.”

Mr Turnquest expressed concern that the proposed NHI capitation scheme could lead to a lower quality of healthcare for all Bahamians, especially if it forced doctors to focus on cutting costs and financial management.

The Government and its NHI consultants have modified their initial proposal, which called for a flat $212 per patient fee across the board. They are now offering a ‘sliding schedule’ of capitation rates ranging from $185 to over $300 per patient.

“What is going to be the doctors’ expectations on payment issues?” Mr Turnquest asked. “What does the capitation rate mean for doctors and the level of service provided to Bahamians.

“It’s one thing to say you want to maintain the current healthcare standards, but if I’m used to accessing a private care provider at a certain standard and he’s now capped, does that bring the level of service down to meet that?

“That doesn’t bode well for the healthcare system in the Bahamas.”

Turning to other potential negative consequences stemming from the proposed capitation payment system, Mr Turnquest added: “We have to be careful that we don’t end up running from the jurisdiction those doctors who have ability.

“If there is a cap on earnings, doctors are like any other business person; they will move their skills to get a better return.”

Mr Turnquest also expressed concern about the “massive cost attached” to creating the Government’s proposed public insurer, Bahama Care, even prior to it commencing operations.

And he warned the Government to guard against ending up with an underfunded healthcare system “that does not meet the expectations of those who genuinely need it [NHI], or those who can afford to pay for a standard of care”.

Pointing out that the Government had yet to publicly release the legislation that will give NHI legal underpinning, the FNM deputy leader warned: “The Government is being incredibly disingenuous with those adverts, saying you must go and sign up for NHI when this programme is not even set up.

“Nor does NIB have legislative authority to share such information. It points to the backward nature with which this Government approaches everything. What autonomy does it have?

“There was no resolution for the guarantee given to Bank of the Bahamas for the transfer of those toxic loans. It would seem as if we’re going happily along while the Bahamian people have been saddled with $100 million in contingent liabilities,” Mr Turnquest added.

“It seems there is a pattern here, and these things don’t happen in an orderly, democratic society. These are things totalitarian societies do.”