The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The National Health Insurance (NHI) scheme’s draft contract with doctors was yesterday branded “cook book medicine” that is incompatible with modern medical practices.

Dr Duane Sands, the FNM’s candidate for Elizabeth in the upcoming election, told Tribune Business that based on the contract numerous healthcare industry concerns have not been addressed by NHI’s architects, and “remain problematic”.

He added that the prohibition on information sharing between doctors was especially concerning, as it meant physicians would first have to gain approval from the NHI Authority - the body that will oversee the scheme, but which has yet to be created - before patients could be referred for specialist care.

Dr Sands warned this threatens to create delays and extra bureaucracy in the patient care/treatment process, explaining that this was “not how the practice of medicine works”.

He added that NHI’s demand that all doctors providing services under the scheme obtain medical malpractice insurance worth $500,000 per event could prove impossible to comply with based on the fee/compensation structure on offer.

“The concerns that were raised when the legislation was produced remain problematic,” Dr Sands told Tribune Business of the draft contract’s contents.

“It is very far-reaching in terms of not being able to share information without permission. Let’s say I diagnose someone with heart disease and need to discuss it with a specialist.

“Technically, I can’t do so without the permission of the NHI Authority, but that’s not how we practice medicine.”

Dr Sands also noted the medical malpractice insurance requirements, noting that the costs of such coverage “can be significant” even for private doctors.

“I’m concerned that the fee schedule, capitated or not, doesn’t cover the level of malpractice insurance they’re demanding; $500,000 minimum coverage per occurrence,” he told Tribune Business.

Dr Sands was speaking after Tribune Business obtained a copy of the draft doctor contract, dated March 23, 2017, and which was described by other physicians as “leaving much to be desired”.

One doctor, speaking on condition of anonymity, told Tribune Business: “I’m sure it’s not anything any of our consultants will be signing off on.

“The terms and conditions associated with this, for most providers, are not going to be acceptable. There are several concerns that have come forward.”

The doctor reiterated the medical community’s long-held concerns over the confidentiality of patient records under the NHI scheme, saying these had been exacerbated by the draft contract’s terms.

The contract seen by Tribune Business makes several references to the NHI Authority and its representatives being able to access doctors’ facilities, and inspect, review and copy patient records to ensure ‘quality of care’.

Medical information is among the most sensitive types of data, and the contract - like the NHI Act - seems to provide no assurances on how the NHI Authority will safeguard any patient records. While the contract refers to the Authority’s Data Privacy Policy, no details or specifics are provided.

“The Authority, for the duration of this agreement, will have the right to inspect, review and make copies of beneficiary [patient] medical records for the purposes of quality assurance, complaint resolution and audits,” clause 13 (4) of the contract stipulates.

This is repeated in section 15 (3), which reaffirms: “The Authority will have the rights to access the primary care provider’s facility and review beneficiary medical records for quality assurance purposes.”

The doctor told Tribune Business: “The big issue is protection of information, which is very important to patients.

“Opening your records for government to assess and review is not an acceptable condition on behalf of any provider, especially with no regulatory body and insurer in place.

“That’s a major issue where, in our environment, we as Bahamians have a very difficult time keeping information confidential.”

NHI is supposed to be overseen and governed by an NHI Authority, which will receive funding for the scheme from the Government’s consolidated fund.

These monies will then be disbursed by the Authority to both the public insurer, Bahama Care, and the private health insurers who agreed to provide services under NHI as Regulated Health Administrators (RHAs). The public insurer and RHAs will then ensure doctors providing services to NHI are compensated for their work.

However, none of this governance structure is yet in place, even though the Government is promising that NHI will launch this month at a date unspecified.

The NHI Authority is supposed to be created from a merger of the Public Hospitals Authority (PHA) and Department of Public Health, but the legislation to effect this - although in circulation for healthcare industry feedback - has yet to make it to Parliament.

With Parliament set to be dissolved next week for the imminent general election, the NHI Authority will not be in place in time for the scheme’s launch.

And nor will Bahama Care, whose management company has yet to be selected, while no agreements have been reached with private insurers to act as RHAs.

Tribune Business’s doctor contact said there was no linkage between the draft doctor contract and NHI’s governance and scheme requirements, particularly the 145-page document that sets out the care and facility standards that providers must meet.

“One has to question how all that fits into the service provider agreement, especially considering there is no actual insurer managing it in place who is going to be responsible for paying the providers that sign up,” the doctor said.

“The question becomes as a provider that there’s nothing for me to sign up to. This is just a political ploy and gimmick by the Government, in my opinion. You’re setting NHI up with no infrastructure in place to provide doctors with payment, and what ancillary care services can they get for their patients?”

Dr Delon Brennen, NHI’s project director, did not respond to Tribune Business e-mails seeking comment.