The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Medical Association of the Bahamas (MAB) president yesterday expressed doubts that the $100 million National Health Insurance (NHI) investment in primary care would help reduce spending on the hospitals.

Dr Sy Pierre told Tribune Business that “there’s nothing primary care can do” for obese individuals who consistently over-ate, meaning they would still represent a burden on secondary/tertiary care providers.

He said the best counter, education and wellness promotion to encourage Bahamians to alter their “lifestyle behaviour”, was a long-term effort that would not generate instant results.

“Out biggest problem is obesity and over-eating,” Dr Pierre told Tribune Business. “Once you start over-eating, there’s nothing primary care can do for you.

“Let’s say the average Bahamian goes into the doctor obese and overweight. They’re [the NHI architects] asking those people at an early age to not eat macaroni and cheese, peas and rice, and to get up early and exercise.

“I’m not saying it can’t be done, but if you’re going to consume 2,000-plus calories per day and sit around watching TV, there’s nothing primary care can do for you,” he added.

“If you’re going to tell a Bahamian to cut out their favourite foods, they look at you as if you have two heads with an eye in each forehead. When I tell them how many calories they need to give up, they say: ‘Doc, you’re trying to kill me.’”

The MAB chief said it was possible to change Bahamian lifestyles and behaviours, but he warned that it was “going to be very difficult to do this in a short period of time”.

Dr Pierre’s comments thus appear to undermine one of the key NHI rationales articulated to Tribune Business by the NHI Secretariat and its advisers, namely that the $100 million primary care investment will boost efficiencies, and help to save money, elsewhere in the Bahamian healthcare system.

In particular, they argued that the improved primary care accessibility and affordability produced by NHI will enable medical problems to be identified and treated earlier, thus alleviating the burden on hospitals and secondary care providers.

Dr Kevin Bowe, the NHI Secretariat’s deputy project manager, told Tribune Business that the Bahamian public healthcare system had been “hospital centric” due to where resources had been concentrated.

“These are difficult decisions for countries and policymakers to take,” he conceded, “but do we continue down the path of investment and high level costs, or do we turn the tide?

“Health promotion is happening without NHI. If we are going to change behaviours, objective discussions must be had in terms of how the country moves on its priorities in health. We want to reach it not in silos, but through a national move.”

Dr David Price, chair of the Department of Family Medicine at Canada’s McMaster University, who is advising the Secretariat and its consultants, KPMG, said tertiary healthcare was consuming ever-increasing sums throughout the world.

“The US is investing heavily in tertiary care; Canada is investing more and more in secondary care and tertiary,” he said. “It’s an insatiable beast.

“And the more you invest in it, the more you need it, and will bankrupt your economy if you invest solely in secondary and tertiary care.

“If you reduce the numbers that need those catastrophic services, you will have an adequate amount of resources to provide to them when necessary,” Dr Price explained.

“The best way to do that is if we can prevent them from getting to the catastrophic stage, and we will eventually save money for the system. The investment in primary care is far less expensive than secondary/tertiary care.”

Simon Townend, a KPMG (Bahamas) partner and head of the accounting firm’s Caribbean advisory business, told Tribune Business that “the returns are greater” by investing in primary care, as the Bahamas is seeking to do with NHI.

By treating, and curing, more Bahamians at the primary stage phase, Mr Townend said the Bahamian healthcare system would enjoy potentially greater savings on secondary and tertiary care.

Pointing out that the $100 million allocated to the NHI primary care phase was equivalent to around 4 per cent of the Government’s $2 billion-plus Budget, Mr Townend said the scheme offered opportunities for this to be “spent more efficiently and transparently” as a result.

“I think the system will create that efficiency,” he added. “We know what amount we’re spending on visits to the doctor, pharmaceuticals, rather than it going into a black box at the clinic. It’s going to follow the patient.

“By pooling the whole population you’ll be able to reduce your own cost. There will be net new investment coming into the healthcare system, a good chunk of new money.

“If we have a stronger primary care system, we can improve the health of the population, people will live longer, you will have less disease and a more productive workforce. I don’t see it as a hurdle; I see it as an opportunity.”