The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

SWITCHING $40 million from National Health Insurance to finance essential capital works will not produce taxpayer value, a Cabinet Minister pledging: "We will not scrap NHI."

Dr Duane Sands, minister of health, told Tribune Business that Bahamians would gain far more from reforming NHI than reallocating its 2017-2018 budget into the "giant sink hole" that is the public healthcare system's near-$89 million financing 'gap'.

Several doctors and medical professionals have privately told Tribune Business that the Government ought to end NHI, and repurpose its funding towards strengthening an existing public healthcare system that is already ailing.

Rejecting their calls, Dr Sands told Tribune Business: "The beauty of a democracy is people have a right to express their views. I have a different view. I believe NHI, as a tool for healthcare reform, a vehicle for addressing the challenges of healthcare financing, and eliminating some of the gaps in funding, is a necessary and valuable tool.

"I don't agree we should scrap NHI. It will allow improved access and equity, particularly for people who do not have access to private health insurance. Could we do things differently, and throw $40 million into a giant sink hole? We probably could.

"But are we likely to get the same value out of it? Probably not. As 10 per cent of the healthcare spend, I believe the NHI infrastructure can do incredible things if managed properly," the Minister continued. "We are not going to scrap NHI.

"I am sure there are some people disappointed to hear that, but I've been taking deliberate care to signal honestly the views of the Prime Minister, Cabinet of the Bahamas and my Ministry in terms of where we're headed.

"I've said we're going to make NHI work, work better, and do it in a responsible way. We're not going to spend $200 million, $300 million, $600 million on NHI unless we're going to collect that money in revenues and funding on new projects. That's unlikely."

Dr Sands's comments are indeed likely to disappoint a significant segment of the medical industry and allied professions, many of whom have argued there are better ways than NHI to finance the Government's universal health coverage (UHC) objectives.

They feel their case has been strengthened by a recently-disclosed letter to Dr Sands from just-retired Public Hospitals Authority (PHA) managing director, Herbert Brown, in which he cited the financing, management, infrastructure and equipment inadequacies threatening to compromise the quality of patient care in the public health system.

His letter revealed that less than 10 per cent of the PHA and wider healthcare system's financing needs have been funded, leaving a 'gap' or shortfall of $89 million.

The end result, according to Tribune Business's calculations, is that out of $98.484 million worth in public healthcare financing needs, some $88.844 million remains to be found. Less than $10 million, or under 10 per cent, has been provided to-date.

Dr Sands, meanwhile, confirmed that NHI's $40 million financing for 2017-2018 had been cut by 10 per cent, or $4 million, as part of the Government's wider initiative to slash public expenditure by that proportion 'across-the-board'.

"We have earmarked, policy-wise, $36 million," he told this newspaper. "That's a policy decision. The national Budget says the bill is $40 million, we but we are operating with a goal in mind to maintain that expenditure at no more than $36 million."

Emphasising that the public healthcare system will have to live within the Government's fiscal constraints, Dr Sands reiterated: "I believe the Prime Minister, the Deputy Prime Minister and the Cabinet have signalled to the Bahamian people that we will not spend significantly more than we capture in revenue.

"Given that we have an explicit goal to balance the Budget within this term, it means that if the revenue performance is not there we're going to have to make some painful decisions to bring in expenditure in line with the money we have."

He added that the former Christie government had sold Bahamians the NHI "dream" for too long, and this had turned into "a nightmare" with respect to the deteriorating public healthcare system.

"This is a real world scenario," Dr Sands said. "In reality, while people are discovering they can't get everything and pay nothing, I believe the reliance on being candid with the Bahamian public, respecting that they understand it even if they don't like it, is far better than selling them a dream.

"The dream went on for a very long time, and it's probably become a nightmare. Here's the facts, here's the money. You might not like the way we've allocated the money, but it is what it is. It is open, transparent, honest and access to information."