The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Private Bahamian doctors were last night said to be demanding that the Government “actuarially verify” the costings it has developed for National Health Insurance’s (NHI) primary care and their compensation.

The Government’s latest NHI presentation, which has been obtained by Tribune Business, breaks down how it has arrived at an annual cost of $102 million for the scheme’s primary care package, which is set to launch this April.

Describing the $102 million figure as a “high scenario”, the presentation pegged total Bahamian primary healthcare costs at $89 million in 2013.

The document, called ‘Enabling Universal Healthcare in the Bahamas, breaks the $89 million down into components, with just over half or $42 million said to have been financed by the Government through the Department of Public Health and Public Hospitals Authority (PHA).

Bahamians financed some $21 million of primary healthcare themselves via ‘out-of-pocket’ expenditures, with a further $5 million coming from the National Prescription Drug Plan (NPDP).

As for the private health insurance sector, the presentation said just 13.2 per cent of its total benefits payouts - some $21 million - went towards primary care.

This figure was calculated using the $270.114 million in private insurance premiums paid in 2013, with just 58.1 per cent of this figure estimated to have been spent directly on healthcare services and benefits.

That gave $157 million as the total private health insurance benefits spend, and multiplying it by the 13.2 per cent proportion said to have gone towards primary care gave the Government and its consultants they’re $20.8 million figure.

Finally, a 15 per cent or $13 million increase in “net national primary care spending” was provided for in NHI’s first year to derive the $102 million figure.

The presentation then revealed how the Government had come up with the $212 per patient annual fee that it proposes to compensate private doctors with under NHI.

The ‘back of the envelope’ style calculation appears to assume a ‘one size fits all’ model will be imposed on doctors, as it is based on a two-physician practice with 5,000 enrolled patients, and people in the same role earning exactly the same salary.

“There are no specifics, and no justification on cost,” one doctor, speaking on condition of anonymity, told Tribune Business. “This is the most crazy thing. Where are these guys getting their numbers, and who is providing them with information?”

The doctor said per patient annual costs for his practice were “easily” two to three times’ greater than the Government’s proposed NHI capitation fee.

“Nor has any of this information been actuarially verified,” they added. “Primary care providers in the Bahamas require that this stuff be actuarially reviewed, so that it can be verified.”

NHI’s actual costs, and who will ultimately finance it and by how much, are among the key questions that the Government has yet to provide answers on. Many regard an accurate costing as virtually impossible at this stage, given that the insurance industry has yet to supply the Government with its data.

The Medical Association of the Bahamas (MAB) and its members are now due to meet the NHI Secretariat on January 19 to discuss the scheme’s primary care model and proposed capitation fees. This meeting, which will take place one day after NHI registration is supposed to start, has been pushed back three days from its initial Saturday date.

“They’re expecting us on January 19, if this thing happens, to sit around and come to some conclusion on what services should be covered/not covered, and costs associated with it,” the doctor said. “It’s an absurd way of thinking.

“Most private physicians have already allocated resources for the upcoming financial year. For the Government to midway through their financial year throw in a monkey wrench, and say: ‘You’re going to have to change everything and your whole business model’ is obviously out of this world.”

The presentation, meanwhile, reveals that the Government’s proposed NHI Act will make it mandatory for all Bahamians and legal residents to register for the scheme.

And insurance companies will have to sell the same NHI insurance products, at the same prices, while also meeting certain unspecified “minimum requirements”.

The roll-out of NHI primary care in April 2016 is to be followed by the launch of specialist services to deal with ‘catastrophic’ illnesses, with the scheme’s fourth phase to see the Vital Benefits Package’s arrival. No dates, though, are provided for the last two phases.