The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Public Hospitals Authority (PHA) is targeting "$20m-plus" in extra revenue this fiscal year, a Cabinet Minister revealed yesterday, adding: "Health can't be run on a wing and a prayer."

Dr Duane Sands, pictured, minister of health, told Tribune Business that the PHA was looking to narrow its $50m funding deficit through a combination of revenue increases and spending cuts, with feed adjustments "just one" of the measures decided upon.

"A number of decisions have been made to basically ensure that the PHA and its hospitals can actively function," Dr Sands said of Wednesday's meeting involving himself and PHA officials. "It includes a number of strategies to reduce expenditure and also to increase revenue.

"The fee schedule is just one of those things. We would have agreed to modify the fee schedule." Some 500 potential fee increases were up for discussion, as the PHA looked to cover the costs associated with providing medical services in an era when the cash-strapped government can no longer meet all its financing needs from the annual Budget.

Dr Sands did not provide details on which fee rises were recommended for implementation, or the extent of the increases, only saying: "There are quite a few. The changes are not uniform across the board.

"We now have to look at the policy and legislative impact of the conceptual approach. Some of these things are enshrined in long-standing policies; some of it may be contractual; some of it may be tied to union agreements.

"While the policy has been set in motion, we need to make sure all of these things are doable. It's not simply a matter of: This is a good idea. Now we have to look at all these things we have suggested and determine what the logistical implications are. How long that will take I don't know. But we did conclude with a number of decisions."

While able to provide a figure for the extra revenue the PHA expects to raise, Dr Sands declined to do so for the proposed spending cuts as these numbers were still being worked out.

"We're going to look at raising another $20m-plus in revenue," he revealed to Tribune Business. "Most of that will come from private services, collection of previously untapped insurance payments, and from some further opportunities for services in the hospital - durable meal goods and food services."

The Minister said the PHA planned to segment its patient population into those who simply cannot afford to pay, and those that have insurance coverage - such as civil servants - that can.

"Fundamentally we've recognised that certainly the PHA remains committed to the view we have to take care of everybody," Dr Sands said. "There are any number of people in our country who don't have the means to afford healthcare.

"That said, there are a large number of people that have insurance, and that insurance is paid for by the Government of the Bahamas. At the same time, we don't want to disadvantage those individuals as well.

"The option is to provide those individuals with private care, no out-of-pocket, and charge appropriately for that care provided in private rooms."

Dr Sands reiterated that Road Act insurance was another "untapped resource", as Princess Margaret Hospital (PMH) treats around 2,000 traffic accident victims per year. And the PHA's relationship with the Physicians Alliance, the main private provider, needs to be better "codified contractually and modernised".

As for spending cuts, he added: "We're looking at certain services that come at a premium, and certain medical services that really add to a significant portion of the cost, so some of these contracts will have to be renegotiated.

"Things add up. We have looked at every single contract inked by the PHA, and we believe with renewals we can provide a fair contractual relationship with vendors that is also more economical to the PHA."

Dr Sands did not provide a figure on the PHA's hoped-for-savings, saying: "We're going to have to go and work the numbers. We don't want to create artificial, arbitrary numbers that we pull out of thin air." He added that some services, such as dialysis, might be shifted into the National Health Insurance (NHI) programme.

A similar PHA-type assessment has yet to conclude at the Department of Public Health, but Dr Sands told Tribune Business: "Running a Ministry on a wing and a prayer is certainly not acceptable in this day and age.

"We're going to have to come up with some options to ensure the financial viability of the areas for which we have stewardship. I'm sure it's going to generate a lot of discussion, as it already has, but just yesterday I got calls from A&E (accident and emergency) that they were overwhelmed with admissions and there were no beds at the inn. This has been the story for weeks."

Dr Sands said solutions could not be found "overnight", pointing to PMH ward construction projects initiated last year that had taken six to eight months to complete. He added that occupancy should be achieved within the next 30 days.

"When we have this type of challenge we have to find realistic solutions, and this will involve human resources, expenditure and infrastructure," he explained.

"At least we're not just standing idly or passively and complaining about problems. We're seeking to improve services to the public, and looking at private-public partnerships (PPPs) for the emergency room and maternal child/mothercare wing. We've got a lot to do but can't stand still.

"There have been significant improvements in A&E and waiting areas. We've just added 10-20 trolleys to make it more comfortable for patients, so there is progress. I'm sure the public would like to see even more, and every single day we're going to keep working at this."