The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Government was yesterday urged to privatise management of its 100 public health clinics by a key adviser to its proposed National Health Insurance (NHI) scheme.

Simon Townend, a KPMG (Bahamas) partner and head of the accounting firm’s Caribbean advisory practice, said there was “no reason” for the Government-owned clinics to be managed and operated as they are currently.

He told the Bahamas Business Outlook conference: “We should be moving more to private sector management of those clinics. There’s opportunities for private-public partnerships (PPPs) in the clinic space.

“There’s no reason why those need to continue to be run in the way they are.”

Whether the Government will act on Mr Townend and KPMG’s recommendation is uncertain, especially given that the Christie administration has always been wary of relinquishing long-held public assets to the private sector.

No such outsourcing is likely in the short-term, given that the Government will be more pre-occupied with implementing NHI’s $100 million primary care phase prior to the upcoming general election.

The Christie administration, though, has exhibited a preference towards outsourcing management, as opposed to privatising physical assets and companies, as shown by the Nassau Airport Development Company (NAD) and Bahamas Electricity Corporation (BEC) deals.

Mr Townend readily admitted that the public healthcare system was challenged with long waiting times, inadequate physical infrastructure and poor treatment outcomes and ‘value for money’, given the annual Government (taxpayer) investment in it.

He said health system strengthening was a key component of NHI, with the goal of “continuous improvement” in the public sector.

“We all understand there are savings to be found in the current healthcare system, which is not the most efficient, and certainly there can be some improvements in processes and technology to save money from the existing expenditure,” Mr Townend agreed.

He reiterated that the NHI primary care phase was contingent on private sector doctors “lifting some pressure off the public system” by agreeing to provide services to the scheme, arguing that many physicians and facilities were “not operating at full capacity”.

Although provider (doctor) registration for NHI is supposed to begin imminently, several physicians have privately told Tribune Business that ‘buy in’ to the Government’s scheme was likely to be low, and many will not sign up.

Some are even viewing the need for private doctor participation as “a choke point” that could prevent the primary care phase’s launch, given that they are needed to both deal with the huge increase in patients and relieve the public system.

Mr Townend yesterday conceded that Bahamians were not receiving ‘value for money’ from the existing healthcare system.

While the $1,819 average per capita expenditure on healthcare equates to around 9 per cent of GDP, a figure in line with many other countries, Mr Townend said the Bahamas was “not achieving the same health outcomes”.

The KPMG (Bahamas) partner added that with a population of 373,496 persons, and an average life expectancy of almost 75 years, just 30 per cent - less than one-third of Bahamians - were covered by private health insurance.

This, he suggested, made government action imperative, given the negative financial consequences for Bahamians who were forced to cover expensive treatments from their own financial resources.

“People go hungry, take out loans, sell assets, and lose their independence and dignity because of healthcare,” Mr Townend said.

“A very important factor here is enhancing social cohesion and the implementation of the Government’s commitment to healthcare as a human right. Who wouldn’t want a healthy population?

“We can do it if we focus on taking action and achieving the right outcome, rather than sitting back and saying we can’t afford to do this.”

Mr Townend said it was “totally understandable” that many Bahamians - especially business owners - were focusing on whether they would have to pay new or increased taxes to finance the NHI scheme.

Emphasising that the Government had stated publicly this would not be required for the initial $100 million primary care phase, the KPMG partner argued that NHI would generate returns that benefited the entire Bahamas.

“A lot of other people are jumping to the concern: What’s the cost? What’s it going to cost my business? How will it affect me? That’s totally understandable; it’s the way people think,” Mr Townend acknowledged.

“Access to affordable healthcare is about improving people’s lives, and developing a healthier, more productive workforce....Improving primary health is a key pillar for a strong economy.”

Mr Townend said he “really hoped” that discussions on NHI and healthcare reform could be “non-political” and “non-sectoral”, although he acknowledged this was likely a forlorn hope in the Bahamas, especially with a general election looming.

He also told Tribune Business that KPMG’s NHI advisory work was being led by its Bahamas office and personnel, refuting suggestions by Dr Sy Pierre, the Medical Association of the Bahamas (MAB) president, that the local economic environment was not being accounted for in the scheme’s planning.