The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Senior physicians have warned the Government that its National Health Insurance (NHI) initiative is “doomed to fail”, unless it substitutes “domination and dogma” for an approach that permits industry stakeholders to buy in to the scheme.

Dr Locksley Munroe, the Consultant Physician Staff Association’s (CPSA) president, said a “transparent, honest partnership” between the Government and healthcare industry players would - although taking longer

In a November 6, 2016 letter to the Government’s chief medical officer, Dr Glenn Beneby, the CPSA chief urged the Government to heed the lessons from other countries’ NHI-type schemes so that the Bahamas’ version “travels that much further”.

“NHI by itself is doomed to failure without engagement of all those currently involved in healthcare delivery,” Dr Munroe wrote in the letter, which has been obtained by Tribune Business.

“A truly transparent, honest and committed partnership with those involved would allow a much longer, satisfying and successful journey than domination and dogma.”

Dr Munroe’s letter carries significant weight, given that the CPSA represents the senior physicians in both the private and public healthcare sectors in the Bahamas.

Unless the private medical community ‘buys in’ to the proposed NHI scheme, it cannot work, and with less than two months’ before the Christie administration’s planned primary care launch, no doctors have signed on as providers.

Few of the other key ‘building blocks’ required for successful implementation have been agreed and completed, and both Prime Minister Perry Christie and his minister of health, Dr Perry Gomez, have recently indicated that NHI’s launch may again be pushed back.

Many physicians spoken to privately by Tribune Business believe the Government will seek to use Hurricane Matthew, and the devastation it has inflicted, as an ‘excuse’ for delaying NHI’s $100 million primary care phase.

They, though, are not complaining about any delays given the significant concerns in the healthcare industry over the scheme that have yet to be addressed by the NHI Secretariat or wider administration.

Dr Munroe’s letter refers to a meeting of the NHI Catastrophic Care committee that was held on November 2, and is described as an “ongoing effort to honestly, on principle, support the country’s effort to find a way to better fund Universal Health Care”.

Universal Health Care (UHC) is the provision of quality, affordable healthcare for all regardless of income or background. It is different from NHI, which is just one means - among many - of financing an NHI scheme.

Dr Munroe, while backing UHC as a concept, urged the Bahamas not to ignore the problems and failings of similar NHI-type schemes, such as the UK’s National Health Service (NHS) and Canada’s health system, in designing its own scheme.

“There are many NHI/NHS schemes in existence,” he said. “Common to each of them is expectation that exceeds outcome, followed by failure.

“Failures demand adjustments. As stated previously, we in the Bahamas have had the opportunity to study these systems and, hopefully, understand the reasons for failure, the reasons for success, and have the commitment to ensure that our NHI system travels that much further prior to facing its own challenges.”

Dr Munroe added: “NHI/NHS is NOT the initiator of health care. With due respect, it should be a complement to the system and hard working professionals already engaged in this field.”

When it came to catastrophic care, Dr Munroe said this had to be properly defined under NHI, along with the money allocated for it.

The annual number of patients treated in the Bahamas per year for catastrophic illnesses needed to be broken down by type, he added, along with the diagnoses that led to “high costs” of care.

Dr Munroe said provider fees for catastrophic care had to be negotiated, with patient outcomes reviewed either annually or every two years.

Another physician familiar with Dr Munroe’s letter and concerns told Tribune Business yesterday that the document highlighted just how much work remained to be done to develop a feasible NHI scheme.

“A letter dated November 6, and in this tone, suggests there is a hell of a lot of work to be done,” Dr Duane Sands, the FNM’s Elizabeth candidate told Tribune Business.

“If the physicians and healthcare providers are to truly embrace NHI, then they ought to be actively engaged and involved in a true partnership, otherwise it is not going to work.

“Here we are on November 9, and a significant part of the roll-out of NHI is the buy in and commitment from the physician body. How do you roll out a programme unless you have buy in from the people who are trained and expected to deliver it? That remains a huge hurdle.”

Dr Sands said he, too, was a member of NHI’s Catastrophic Care committee, and acknowledged that its members had discussed how to move this from a concept to implementation.

“The meetings have been productive and fairly comprehensive,” he added. “But if you were to ask me, frankly, if there is a product ready to be rolled out today, the answer is: No.”

With just $24 million allocated by the Government for catastrophic care alongside the $100 million roll-out of NHI’s primary care phase, Dr Sands said there would inevitably be “limits” on who could be assisted, and how much help they will receive.

“When you look at the challenge of providing catastrophic care and assistance to the population in the setting of a limited budget, which is $24 million, this has to be done with great care to ensure it is fair and equitable,” Dr Sands told Tribune Business.

“Who do you cover? Who do you help? How much do you help? Who decides who to help? These are the challenges, and the questions have to be clearly articulated.”

Given its pre-election target for NHI’s roll-out, Dr Sands said “time is not on the Government’s side” in terms of addressing the catastrophic care issues, let alone NHI’s wider problems.

“Implicit in a $24 million cap is that not everyone with catastrophic problems will get help,” he told Tribune Business.

“If you want to be fair and maximise assistance to as many persons as possible, there will clearly have to be limits. What does that $24 million budget support?”