Fees revolution to help fund $50m health deficit

Health Minister Dr Duane Sands.

Health Minister Dr Duane Sands.


Tribune Business Editor


Health officials will meet today to decide on the implementation of up to 500 fees at the Princess Margaret Hospital (PMH) as they seek to narrow a $50m funding shortfall.

Dr Duane Sands, minister of health, yesterday told Tribune Business that the Public Hospitals Authority (PHA) and other healthcare system elements are faced with “making some difficult decisions” that might result in “certain programmes and services” being stopped or cut back.

He suggested this might include in reduced hours and/or closures at some public sector clinics, as the Government’s fiscal crisis means it no longer has “an infinite source of funds” to underwrite a system where 87 percent of PHA patients pay nothing for the care they receive.

Reiterating that the days of a “free lunch” were over when it came to healthcare, especially for Bahamians who can afford to pay or have medical insurance, Dr Sands said he was targeting “anomalies” that had allowed such persons a ride at the taxpayer’s expense.

He cited the “exemption” that currently allows civil servants to enjoy free healthcare from the PHA, even though the Government pays $75m annually for them to have medical insurance, as one such “anomaly”.

The Minister also pledged to “aggressively go after” potential revenue sources such as Road Traffic Act accident claims and compensation paid to workers injured on-the-job, pointing to the vast pricing gulf between the private and public healthcare sectors.

While a bed in Doctors Hospital’s intensive care unit (ICU) cost $2,000-plus per night, a similarly staffed and equipped bed in the same unit at PMH “bills for no more than $200 a night”. Dr Sands said the difference, with private sector prices ten times’ higher than its public sector counterpart, “makes absolutely no sense”.

Estimating that introduction of the proposed 500 PMH fees could occur six weeks after a final decision is made, the Minister of Health told Tribune Business: “We now need to take that from concept, given the budget and the anticipated deficit.

“We’re meeting on Wednesday afternoon [today] at 2pm; the managing director of the PHA, and the various hospital administrators and financing folks, to conclude these discussions.”

Dr Sands said a combination of “revenue enhancement” measures and spending cuts were being eyed to narrow the PHA’s now-typical financing shortfall in the Government’s budget, which appears to be increasing on an annual basis.

“We may have to stop certain programmes or certain services, but increase fees and charges to eliminate the shortfall,” he warned. “Based on the budget requests versus what was allocated, it could be as much as $50m .

“The challenge is we’ve got to make some serious decisions about maintenance, infrastructure, quality of services, nursing retention and other things kicked down the road repeatedly. We can’t do that any more. We have to make some difficult decisions.

“We have to look at the public health arena, the public clinics. While they are extremely important to the communities they serve, if there are adjacent clinics and we can achieve economies of scale, we may have to close certain clinics, cancel services and reduce hours,” Dr Sands continued.

“The decision will have to be made to avoid any real disruption. In essence, at the end of the day there is no infinite source of funds, so tough decisions have to be made.”

He emphasised that critical healthcare services will not be affected, with the Government’s focus titled towards revenue enhancement so that the PHA can recover its costs.

“Given that certain things are essential services we have to have increased revenue,” Dr Sands told Tribune Business. “In the pot of available income there’s only so much diversion and reallocation we can do. I’m sure the other ministries are doing similar exercises.”

Predicting that today’s meeting on the proposed fees will generate “significant discussion”, he added that the process from decision to implementation will take around six weeks. The Minnis Cabinet will have to ratify the outcome, while financial projections must also be submitted to the Ministry of Finance.

Dr Sands said the PHA was set to target long-standing revenue sources that have been ignored, sometimes for decades, in a bid to close its financing deficit/gap and improve service quality and infrastructure.

“There’s some simple things,” he told Tribune Business. “There’s an anomaly in the charges; the exemptions that were created when there was no insurance for the civil service. In the PHA, civil servants don’t pay, but they have health insurance paid for by the Government of the Bahamas.

“If there’s a situation like that, which is clearly an anomaly, we’re going to make the case that if we’re already paying for that benefit the hospital should be able to generate revenue to pay for it.”

Dr Sands said Bahamian taxpayers, via the Government, paid $75 million annually to ensure politicians, civil servants and the security services enjoy medical insurance cover. “It would seem to make sense that it would be the PHA benefiting from that,” he added.

“It would go a phenomenally long way to improving service, supplies. Perhaps that alone opens up beds that are closed.” The Minister said 87 percent of patients accessing care through the PHA pay nothing towards it, with the prime beneficiaries of civil service health insurance being Florida medical facilities and the private sector.

Identifying other potential revenue sources, Dr Sands added: “We have a huge problem with road accidents, and the vast majority of patients accessing care do not pay.

“The Road Traffic Act provides cover for personal injury. If somebody is injured in an automobile accident, why should the PHA not benefit from claims made under that Act.

“We’re going to go aggressively after that revenue, and workers compensation for industrial injuries and accidents. “We’re going to look at all these things to capture revenue being lost to the PHA.”

Turning to the disparities between public and private health sector pricing, Dr Sands said: “An ICU bed at Doctors Hospital costs $2,000 plus per night. A similar bed, equipped and staffed, at PMH bills for no more than $200 a night.

“If someone has an insurance policy they go into Doctors Hospital and pay $2,000 a night. You go to PMH and pay nothing if you’re a civil servant, but it’s only $200 a night. That makes absolutely no sense; same bed, same service.”

Dr Sands added that beds at PMH’s neonatal intensive care unit, which he described as “even more specialist and sophisticated”, charged $80 per night. “Many of the insurance policies will not pay for neonatal care in the Bahamas, but they will if the baby is transferred to south Florida,” he said.


Porcupine 4 years, 10 months ago

Dr. Sands,

Your argument does not hold water. Health care is a human right. You are asking the Bahamian people to suffer the effects of even further reductions in health care because of fiscal malfeasance, corruption and graft. Our health clinic in Andros is in a sub standard building, we have no doctor, reduced medicines. Blame the last administration if you want, but you and Minnis could see to it that basic human principals ruled. You two haven't, and doctors both. How sad. No, we are in the state we are in because like all the rest of the politicians, you kowtow to the money men. You could declare that before any other expenditure in this country, whether Carnival, Junkanoo, having governmental "entourages" flying all over the world, paying the thousands of Inland Revenue employees, you would, first and foremost put the health needs of Bahamians above all else. We have no leaders to speak of in this country. This, is a perfect example. Health care is about human decency. And you can't even work up the brain power and moral courage to stand tall. Ugggg.


geostorm 4 years, 10 months ago

Stop being so political. The PHA under successive governments have been operating at a loss. It's time to stop the hemorrhaging and make people pay for some of these services so that we can at least provide minimal standards of care.

Carry on Dr. Sands and the PHA. Review those fees and be sure to put measures in place that will force the public to pay. You can't do that in the US, if its not a life or death situation, you will pay for those services.

How else do you people expect health care to be provided!


Porcupine 4 years, 10 months ago

How much do you pay for police services? Or, how about fire department services? It is a matter of priorities. I don't say don't charge anything. But, at least provide decent service. It ain't happening now. You been to the wards in PMH lately? I have. It ain't pretty. Everything is political.


TheMadHatter 4 years, 10 months ago

"...the days of a “free lunch” were over when it came to healthcare, especially for Bahamians who can afford to pay..."

Yes. Especially Bahamians. The free lunch will continue for dem udda set.


joeblow 4 years, 10 months ago

When will Sands be shuffled to some place like Road Traffic or Monuments and Antiquities?


Well_mudda_take_sic 4 years, 10 months ago

Our public healthcare system was doomed by our illegal immigrant problem...mainly of the Haitian kind....and stands no chance of ever becoming functional again unless and until that problem is addressed. QC Smith will be the first to file a legal action if impoverished illegal immigrants are denied basic healthcare services for financial reasons. But Sands, like all of our politicians, refuses to forthrightly address the real causes of our failed public healthcare system, specifically illegal immigrants, and graft and corruption by doctors, by medical supply and equipment providers, and of course by our corrupt politicians and senior officials within the public healthcare sector.

“If someone has an insurance policy they go into Doctors Hospital and pay $2,000 a night. You go to PMH and pay nothing if you’re a civil servant, but it’s only $200 a night. That makes absolutely no sense; same bed, same service.”

Does Sands really believe the hogwash he espouses in comparing PMH and Doctors Hospital - "same bed, same service"....really? I suppose he will next say "same nurse, same service" or "same doctor, same service." But of course we all know that if Sands or Minnis, or any other cabinet minister for that matter, should become seriously ill, they would be on a plane to a hospital in the U.S. in a heart beat.

Sands suggests many civil servants have been receiving free healthcare services from PMH under a cost-exemption benefit granted to them by government even though the government has been paying $75 million a year to private insurers for these same civil servants to have generous healthcare benefits. It seems certain private health insurers have been laughing all the way to the bank, receiving healthcare premiums without having to pay out claims because insured civil servants had the cost-exemption benefit granted by government (the PHA) for healthcare received at PMH. Why doesn't Sands name the private Insurer(s) that have been ripping us off because of the government's asinine cost-exemption policy for civil servants who have private healthcare insurance paid for by the taxpayers?!

There's much too much other foolishness here to even bother commenting on. Both Sands and Minnis have spent years practicing medicine in the Bahamas and each has enjoyed professional affiliations with PMH. Minnis was even Minister of Health under the last Ingraham-led administration. These two doctors (Sands and Minnis) have known for decades about all of these problems but neither did a darn thing towards fixing them during their professional years. And now, as politicians, we can only expect them to give our healthcare crisis lip service rather tackle the root of the problem - illegal immigrants burdening a system to its death. Our public healthcare system is dying much like our general postal system has died. Truly sad.


DDK 4 years, 10 months ago

Either they have known and are just spewing political rhetoric for our supposed benefit or they are truly dim-witted. (Not sure how competent doctors could be dim-witted, but there you are!)


bogart 4 years, 10 months ago

Present side accusing past of collecting 2.5 billion in VAT since 2015...an now not only anodder 2.5 billion plus will be collected but on top 5% added more to 7.5%....plenty wrongs found in Road Traffic money by AuditorGeneral.an odder places....an pore people have to pays fer slackness odder people doing.....but Pore people gon feels it more as vat is consumption tax...more pore people dan rich people....if yinna knows pore people like pore people know pore people....jus gone mean more pore people gon not be able to afford medical servoces an suffer...be in pain....blood pressure....more stress...disease....blind...die...


DDK 4 years, 10 months ago

"Dr Sands said Bahamian taxpayers, via the Government, paid $75 million annually to ensure politicians, civil servants and the security services enjoy medical insurance cover. “It would seem to make sense that it would be the PHA benefiting from that,” he added." YOU WOULD THINK! Government it tied by the umbilical cord to its civil servants.

On the other hand, we seem unable, or unwilling, to put healthy fresh foods and whole grains in the Bahamas bread basket, but continue to be of the opinion that condensed milk, corned beef and mayonnaise are healthy foods. Never could figure out the mustard LOL! Maybe it lucked out because it is spread with mayonnaise on white bread!


Well_mudda_take_sic 4 years, 10 months ago

Most of us would not bother with the tedious task of filing healthcare claims and then having to following up on their payment if we didn't have to do so in order to get exactly the same healthcare services free of charge and without any paperwork on our part. I can just hear most civil servants saying: "Child, why I gonna fill out and file all d'em claim papers and have to deal with all d'em confusing insurance people when I gonna get da same treatment at PMH anyhow under ma generous civil servant cost-exemption benefit?" Can't say I blame the civil servants for taking the path with the least amount of paperwork and headaches. This ridiculous situation really speaks much more to the outright stupidity of our politicians, both past and present.


Naughtydread 4 years, 10 months ago

The new slogan for the Island of the Bahamas should be "Pay More Get Less" this country is looking worse by the day. Soon people won't be able to afford corned beef.


birdiestrachan 4 years, 10 months ago

12% VAT and now this?? What next. Roc wit doc must need lots of money for his and others like him travel expenses, All should pray to God for good health unless many will die.


TheMadHatter 4 years, 10 months ago

I believe the money is a problem. We are in a financial mess - but it is made more stressful for the public because we have ZERO information on what monies are coming in by dept and island and what monies are going out by dept and classification and island on a monthly basis.

These folks at Finance would never be able to keep up with the accounting at ANY company in the Bahamas that has more than 3 brances/locations. They would be all confuse' up.


OMG 4 years, 10 months ago

Maybe Dr Sands would like to look into nurses (usually senior) selling medication,using two sets of books, charging but refusing to give reciepts,taking a slice of emergency flight charges and on and on..And when caught prosecute don' just move them.


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