The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Government’s proposed National Health Insurance (NHI) scheme threatens to increase doctors’ costs by “at least 20 per cent”, amid competing proposals to reform the profession’s relationship with insurers and the Government.

With the Christie administration desperate for progress on its long-promised heathcare reforms prior to the general election, rival groups are proposing that private doctors/physicians form themselves into an Independent Practice (Provider) Association.

Such an Association, or IPA, would negotiate insurance contracts with both the Government’s NHI Authority and private sector providers on behalf of its members, allowing those doctors to focus on the quality of patient care and the latter’s experience, as opposed to managing costs and administrative issues.

Tribune Business has obtained both the competing proposals, one from a Partnership of Healthcare Providers (PHP), a Bahamian grouping, which appears to be based on presentations by the JPIA Network.

That is an organisation of international Independent Provider Associations (IPAs) that provides services to 300,000 independent doctors in the US, Caribbean and Latin America.

With the Government understood to not be in favour of a foreign provider, the PHP proposal was quickly followed by a rival submission from Dr Conville Brown, entitled ‘The Case for an IPA for universal healthcare in the Bahamas’.

Setting out his argument, Dr Brown warns that the NHI Bill has “major implications for the healthcare providers”, particularly the requirements associated with record-keeping.

“These regulations highlight, in particular, the need for physicians to establish EMR (electronic medical records) and management information systems,” Dr Brown’s paper says.

“The regulatory requirements underpin the objectives and values of the patient-centred home (the healthcare model favoured by the Government and its consultants, Sanigest).”

“The inspectors have wide sweeping powers, and the penalties are extremely punitive: Up to $50,000 fines and years of imprisonment,” Dr Brown added.

“These regulatory requirements will add major expenses to their [doctors’] practice – at least 20 per cent with additional staff and equipment.

“There have been no government grants to defray expenses, and no formal programmes to assist the physician in delivering these new models of care.”

The IPA proposals have surfaced just as the pace of consultation on the Government’s universal healthcare (UHC)/NHI reforms has picked up once again.

Tribune Business understands that the Government wants to bring the revamped NHI Bill to Parliament next month, and its consultants, the KPMG accounting firm, have been meeting with doctors and other healthcare stakeholders either individually or as groups.

Yet the increased costs foreshadowed by Dr Brown will again raise concerns over NHI’s feasibility and sustainability, given the prevailing weak, uncertain economic environment.

His paper points out that rising expense pressures threatened to exacerbate “the high and increasing cost of healthcare”, which was already reflected in its share of the Government’s annual Budget.

The paper pointed out that Government healthcare spending had “doubled” between 2001 to 2010, with 9.7 per cent of Bahamian GDP going towards the sector per year - a sum equivalent to 2,233 per person.

It added that the Government’s healthcare spending, which had increased from 14 per cent to 19 per cent of its Budget between 2009 and 2013, was expected to increase by $36 million per year between now and the 2019-2010 fiscal year.

“We are in the 90th percentile in health care spending in the region, but we have lower life expectancy and higher infant mortality rates than those in the region who are spending considerably less. We are not getting value for money,” Dr Brown argued.

“This lends to considerable waste and inefficiency in the system. One can make the case that no new money need be injected into the health care system; we need only to improve efficiency and minimise wastage.”

Against this background, both Dr Brown’s proposal, and the rival PHP model, argued that forming the IPA model would help to generate efficiencies and savings under the Government’s NHI/universal healthcare model.

“This model represents the most modern way of administering health care based upon evidence, and will serve to better unite the Bahamas private and public healthcare systems,” the PHP proposal added.

“The IPA Model of healthcare will work in the Bahamas as this is the best model of healthcare delivery in a ‘free market’ health care environment, because of the natural controls that can be put in place to force compliance, efficiency, quality, unity among providers, economies of scale and financial responsibility.”

Dr Brown, meanwhile, wrote: “Healthcare costs have spiralled far beyond the allotted budgets of both the public and private sectors.

“Driven by consumerism and an aging population, the demands for healthcare services have outstripped available resources. This is a global phenomenon, as every country faces the challenges of access, availability, affordability and equity of care for all.

“Healthcare reform has become the new mandate in health care services, and to meet the triple aim in healthcare: To improve the healthcare experience of the individual, to better the health of the population, and to provide healthcare at lower costs. To do this, our delivery systems must be better managed with greater efficiency and quality.”

Arguing that it was too “cost prohibitive” for doctors to focus on both quality of care, negotiate insurance contracts and manage costs, Dr Brown added: “The need for establishing partnerships to share costs and resources and to provide leverage for negotiations of their reimbursements has never been greater. This need gave birth to the Independent Practice Association.”

He added that IPAs would handle administrative functions related to cost-control on behalf of their members, allowing doctors to focus on patient care and quality outcomes/experiences.

And, with insurance companies also returned to their rightful place of underwriting risks, rather than getting involved in healthcare delivery, Dr Brown said an IPA would ensure patients were not denied access to treatment.

“In essence, the IPA gives the physician the responsibility to manage the care of the patient and leaves the insurance company with the responsibility to do with they do best: Determine the insurance functions only; the available health benefits, the actuarial cost, payment processes and financial viability,” he added.