The Tribune

ALTHOUGH Prime Minister Christie is satisfied that he is on the right track to introduce government’s national health insurance plan, he has decided to call in an outside group of consultants to satisfy the naysayers.

He has assured Bahamians that he has had the “right advice” from both his Costa Rican advisers — Sanigest – and his Bahamian consultants –

PricewaterhouseCoopers.

As far as we recall, PricewaterhouseCoopers hoisted the red flag to advise caution. “Implementation of NHI as it is currently proposed has the potential to seriously destabilise both the public and private sectors of the health care system, risking the success of NHI,” was the warning that PricewaterHouse gave. This seems pretty much in line with what the doctors are saying.

Mr Christie says he is talking with the doctors and is willing to continue to answer their questions. However, what we hear from many of the doctors is that when they make a point to Mr Christie or his stand-in, he listens and remarks: “Yes, we understand, good point, we will take it into consideration” or “Tell us what your concerns are and we’ll get back.” That’s the end of the information exchange — a complete brush off and no feed back. No wonder the doctors feel demeaned. They believe that government is doing what it wants and making few concessions to the concern of the medical profession.

And then there is Labour Minister Shane Gibson criticising the Consultant Physician Staff Association for their non-suppport of the system as it is now designed, insultingly suggesting that senior doctors are more interested in “making the mighty dollar” than saving lives. What brass, especially coming out of the mouth of a person like Shane Gibson.

Dr Bernard Nottage, now Minister of National Security, has tried to distance himself from Mr Gibson’s insane remarks — almost as insane as his recommendation that government should now begin performing “psychological evaluations” on all foreign developers seeking to do business in this country. And you wonder why The Bahamas is in free-fall with men like this in charge of its destiny?

Dr Nottage has assured the public that Mr Gibson’s statement is not supported by government. We wager that if Dr Nottage were in private practice he would probably be lined up with the consultants.

The doctors with whom we have spoken are genuinely concerned for the welfare of their patients.

For example when their salary is cut in half, they are airily dismissed with the assurance: “Oh, don’t worry, you’ll get more patients.” Yes, but what of the patients?

Suppose a doctor can only safely see 15 patients a day. However, government insists that he see 30. Again — what of the patients? To see 30 patients a day, the doctor is forced to reduce the time that he allows each patient — it is a conveyor belt system — and the patient suffers. Yes, the patient will see a doctor, but he will not get the standard of care that he deserves. There will be care, but the care will be inferior. Doctors, who really care for their patients, are concerned that the patient is being cheated. Such care not only demeans him as a professional man, but it demeans the patient. So be prepared. If this system is implemented, as government says it will be, and you have a complaint, go see Prime Minister Christie, maybe he will be able to give you a better answer than he has given the doctors.

Now for Mr Gibson’s remark suggesting that doctors are only interested in “making the mighty dollar”. If he had invested as much in his own education as have the doctors he would have had more sense than to make such an insulting remark.

It takes years for a doctor to qualify – five years medical school, 18 months in the Bahamas to intern; two to three years on average as a senior house office, and another five years to specialise. From an intern to a specialist he is earning a minimum wage.

Then there is the expense of setting up in practice. Not only is medical equipment expensive, but until recently government had put a 45 per cent import duty on this equipment. Now there is no duty on certain equipment — instead there is the VAT tax.

It is also a very expensive exercise to purchase and install equipment to produce electronic medical records. The purchase of this equipment would be in the region of $60,000, on top of which the purchase of the computers would be another $100,000. Also there are the servicing and licensing fees — add another $120,000 to $130,000. In addition to this there is the outlay for the IT (Information Technology) experts – contracts that cost more than $1,000 a month, in addition to the cost of whatever machine part has to be either mended or replaced. Then there is the maintenance contract on all medical equipment, for example such machines as the CAT scan, ultrasound and others. This cost at least $15,000 a year for each machine. (Is Mr Gibson keeping up with us, or is this too much for him to compute when he is dealing with greedy doctors?)

And, of course, there is no allowance for replacement or depreciation of equipment. Then too are government’s utility costs — water, electricity and telephones. Add to this salaries of staff required to maintain such offices, and the rental of the office space.

This is only a superficial view of the cost of private medical practices. This is why the equipment in the Princess Margaret Hospital is non-functional and the wastage so high — the answer is neglect, negligence and more negligence.

We shall return to this subject again.