Nhi Advisers ‘Look At Healthcare In Vacuum’


Tribune Business Editor


The Government’s National Health Insurance (NHI) advisers were yesterday accused of “looking at healthcare in a vacuum”, and failing to account for the numerous economic and social factors that drive high Bahamian medical costs.

Dr Sy Pierre, the Medical Association of the Bahamas (MAB) president, told Tribune Business that foreign consultants had “no idea” utility and other operating costs were five-six times’ higher in this nation when compared to their home jurisdictions.

Yet they were seeking to impose their own healthcare “template” on the Bahamas, he added, arguing that their cost and utilisation estimates were more suited to Canada or the US.

“Everyone is looking at healthcare in a vacuum,” Dr Pierre said. “You have the [stabbing] at Government High today, we have an unemployment rate that is truly around 30 per cent, we are being taxed to death, have electricity costs that are the highest in the world, and medical equipment that attracts a 100 per cent tax at the border.

“These guys come here, these consultants, seeing this amount of people and amount of money, and are trying to stick it on a template for healthcare. These guys haven’t seen gas at nearly $6 per hour. You can’t look at healthcare in a vacuum.

“All these costs that we incur, they have no idea about in Canada, in the US.”

Dr Pierre said that in developed nations such as these, consumers could purchase a cell phone, obtain service and acquire unlimited data and calling packages for $50 or less.

Water and electricity bills, he added, frequently came to less than $100 per month. Florida Power & Light bills, the MAB chief charged, were as low as $1 per day, or $30 per month.

“These guys come here and say it’s going to be enough.,” Dr Pierre told Tribune Business of the NHI advisers. “It’s enough if they lived in Canada or we have the governance structure they have in Canada, the UK and US.

“We don’t have income tax, but our taxation for businesses is exorbitant. It’s important for them to address that. And for them to come here and say that is enough, they haven’t looked at the sickness of the people.”

Dr Pierre pointed to the Bahamas’ having one of the highest rates of diabetes and heart disease in the world, something that the Government and its consultants have acknowledged in documents obtained by Tribune Business.

However, the MAB chief continued his criticism of the NHI advisers, saying: “I don’t like them coming, saying they have all this money, it’s going to work and take care of ‘x’ people for ‘y’ dollars because it’s been done elsewhere in the world.

“The problem is they’re looking at healthcare in a vacuum, not looking at all the costs.”

Dr Pierre was speaking out after Dr Price, chair of the Department of Family Medicine at Canada’s McMaster University, suggested that NHI’s compensation mechanism would have “a pretty good cushion” to prevent doctors suffering financial loss.

Dr Price, who is advising the Government’s NHI Secretariat and consultants, the KPMG accounting firm, said compensation rates being based on Bahamian doctors receiving 2.2-2.3 visits from each patient per year.

This, he told Tribune Business on Wednesday, was three times’ higher than the average 0.7 visits per patient, per year, that Bahamian doctors currently experienced.

Dr Pierre, though, pointed out that the $100 million allocated by the Government for NHI’s primary care phase amounted to just $500 per person, per year, for the 200,000 Bahamians who lack private medical insurance.

The MAB chief said it was unlikely this $100 million was dedicated solely to paying doctors’ fees, and said it paled in comparison with the lowest private health insurance rates, which currently amount to $350 per month.

“The KPMG people are being paid by the Government to sell this,” Dr Pierre told Tribune Business. “We’re the ones being left holding the bag.

“These guys come here, get consulting fees and leave. I just don’t want people to be fooled by this..... People have to be realistic about what to expect from NHI.”

Private Bahamian physicians are also opposed to NHI’s preferred payment mechanism, capitation, which would see them receive a set fee per patient, per year, as opposed to the current fee for service model.

The NHI secretariat and the Government subsequently tweaked the payment plan, giving doctors a choice of capitation, fee for service or a hybrid of the two when the primary care phase is launched.

However, Dr Price confidently predicted to Tribune Business that Bahamian doctors will drop their opposition to capitation “within three years”.

He and KPMG argued that argued that capitation had numerous merits, as it provided doctors with a predictable, set income upon which they could base their business and investment decisions.

They added that it would also “incentivise” doctors to keep their patients healthy and engage in preventative medicine, resulting in better treatment outcomes and greater patient satisfaction.

Dr Pierre, though, laughed when Tribune Business mentioned Dr Price’s capitation prediction, saying: “I doubt that seriously.”

And another doctor, speaking to Tribune Business on condition of anonymity, described the ‘0.7 visits per year’ base figure, upon which the capitation mechanism and NHI utilisation rates are based, as “complete BS”.

The source told this newspaper that when they met with the NHI secretariat and its advisers, the representatives present “completely admitted that one of the reasons health insurance costs are so high is because Bahamians over-utilise it; they’re in the doctor all the time”.

They predicted that once NHI’s primary care phase was launched, Bahamians would “flood” doctors’ offices in the belief they were receiving free healthcare, thereby vastly exceeding the forecast 2.2-2.3 visits per year.

The doctor, though, said it was by no means certain that Bahamians would be able to get into see their physician under NHI.

Given that doctors were receiving a set fee per patient, per year, and there were limited hours in a day, the source said some physicians may be reluctant to see those without a prior appointment - especially if their capitation budget was exhausted.

“Bahamians are going to flood the doctors,” the source said, “but they may not get in. Doctors can only see so many a day. If you don’t have an appointment, you can’t get in.

“What’s the point of having insurance? If you don’t get into see your doctor, you don’t have healthcare. You will have waiting lines, and they [the NHI secretariat and advisers] know it. This is the way a socialised medicine system works. That 2.2 means nothing.”


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