The Tribune

By RASHAD ROLLE

Tribune Senior Reporter

rrolle@tribunemedia.net

PRIME Minister Dr Hubert Minnis said the government aims to save $62 million in healthcare costs over the next five years by integrating public healthcare systems, using the National Health Insurance programme as the anchor.

He also said the Public Hospitals Authority must move to collect fees for services provided, "especially from those who have the ability to pay." The PHA should focus on revenue enhancing measures that include repealing and replacing "gazetted fees to reflect the true cost of care," he said during his budget communication in the House of Assembly.

Dr Minnis said NHI currently has 77,000 enrolled beneficiaries, up from 55,000 a year ago. The budget allocation for NHI authority has increased from $20m to $38 million.

The 47.3 percent increase in funding demonstrates the success and popularity of NHI, he said, and signals reduced loads on public clinics. He said the programme grows by about 2,200 beneficiaries per month.

Dr Minnis said NHI delivers services at a cost of $217 per beneficiary each year, lower than the cost of service provided by other parts of the public healthcare system and private insurance companies. In fact, he said overall primary care delivery could increase by $44.4 million to $128 million by 2025 if the model is not significantly changed.

He said the healthcare system now is too fragmented, with the National Health Insurance Authority, the Public Hospitals Authority and the Department of Public Health all receiving funding. Those institutions "represent a duplication of services, inefficiencies in resource allocation, disconnected care delivery and a lack of consistent service standards," he said. "Taken together, these result in excessive healthcare costs--among the highest in the region--and an overall lower quality of care being delivered to Bahamians."

"Aside from reducing the burden currently placed on the public purse by this entity, major reform of the primary healthcare system in the Bahamas will be the central tenant of our health care spending, as we seek to provide accessible, affordable, accountable and value-driven health care for every Bahamian. We are on a journey to universal health care, and improvements to our primary health system is a first step."

Dr Minnis said the National Health Insurance Authority will lead a series of reforms known as NHI 1.1. "This initiative is estimated to save the government of the Bahamas approximately $62 million over the next five years," he said. "It will require no additional taxation or employer mandate which would have included a mandated insurance premium, and will mean minimal disruption to the private health insurance industry.

"Indeed, it will ensure that every Bahamian and resident has consistent access to a family doctor without a co-pay or deductible. NHI 1.1 will be funded by the savings created by consolidating and reorganising programmes to eliminate identified inefficiencies in the primary healthcare system. The NHI 1.1 framework integrates primary care programme delivery under the existing NHI model by establishing a single standard primary care health benefit for all Bahamians and residents.

"This benefit will include existing NHI coverage for visits to a family doctor, laboratory tests, as well as new diagnostic imaging services, cancer-screening programmes and an emphasis on patient-centered care. The NHIA will engage all providers of these benefits on a contractual basis, and all services will be made available without co-pays or deductibles. The changes will integrate the Public Hospitals Authority (PHA) and the Department of Public Health (DPH) primary care clinics under the NHI model. It will extend the benefit of an electronic health record to all Bahamians and residents, and implement the NHI quality programme for all primary health care facilities in both the public and private sector.

"The estimated cost to deliver NHI 1.1 in 2025, which will provide additional benefits beyond what is currently provided, is $110 million. This represents savings of some $17 million over the next five years. We can realise these savings by reducing the number of primary care clinics directly operated by the Department of Public Health and Public Hospitals Authority and engaging private sector capacity through public-private partnerships. NHI 1.1 will also reduce capital expenditures at public health facilities and decrease the burden at secondary and tertiary care facilities as a result of improved primary care access. With its innovative contractual reimbursements with private providers, NHI 1.1 will emerge as a model public-private partnership where public funding seeks to harness and leverage the efficiency, creativity, responsiveness and accountability of a privately delivered healthcare service. Over the near term, NHI will commence detailed planning discussions and mobilise a project transformation office in coordination with the Ministry of Health, Ministry of Finance and Public Hospitals Authority. Shortly thereafter, NHI will once again undertake formal stakeholder consultations, which will allow Bahamians to have meaningful input to the proposal."

As for opportunities to maximise revenue-enhancing initiatives, Dr Minnis said PHA should "pursue measures to correct systemic challenges to registering, billing for, and collecting on services rendered." PHA should engaged the NHIA for healthcare services via "formal provider agreement that will allow PHA's core laboratory at Princess Margaret Hospital and its primary care clinics to be registered as NHI providers," he said, saying this would guarantee equitable access to care for NHI patients and generate revenue for the authority "in the form of capitation payments for PHA's patient panels."

Dr Minnis said PHA should implement bundled billing for services, target third-party payers, negate preferred provider status with insurance companies and review and revise policies and practices that impede revenue collection.