By NEIL HARTNELL
Tribune Business Editor
nhartnell@tribunemedia.net
A withdrawal by the Medical Association of the Bahamas (MAB) and its members of all co-operation with the Government over National Health Insurance (NHI) was yesterday branded “a possibility” ahead of a crunch January 16 meeting.
Senior professionals within the medical community, speaking to Tribune Business on condition of anonymity, confirmed that the MAB was hoping “not to get to the point” of ceasing all co-operation with the Christie administration.
However, Dr Duane Sands told Tribune Business that such action remained the medical community’s “trump card” should the Government fail to deal with its multiple concerns over the proposed NHI model and how it will affect private physicians.
The MAB and its members have enormous leverage over the Government when it comes to NHI, as the scheme’s implementation is not feasible without their buy-in and co-operation.
A total withdrawal would mean there are too few doctors for the 350,000-strong population that will be covered by NHI, giving the medical community much more clout than the private insurers, which can be outflanked by the publicly-owned entity, Bahama Care.
Tribune Business understands that despite the positive ‘front’ put on by the Government and its consultants, there is mounting concern over its relationship with private physicians and whether they will be fully ‘on board’ with NHI in time.
James Cercone, president of Sanigest Internacional, the Government’s primary NHI consultant, is said to have been on the phone daily with key MAB executives in recent weeks, which some are interpreting as a sign of nervousness on the administration’s part.
The MAB has already rejected the preferred NHI care model, the Patient Centre Medical Home (PCMH), as “culturally and organisationally unacceptable” in the Bahamas.
The Association, and its members, also fear the Government’s requirement that they take on 5,000 patients per practice will dilute the quality of healthcare,and have criticised the proposed capitation payment method for their services as transforming them from carers into financial administrators.
The proposed $212 capitation fee per patient, per year, has also been slammed for vastly under-estimating healthcare costs in the Bahamas.
“What will the Bahamian people get for $212 for health care per year?” one doctor told tribune Business via e-mail.
“An annual medical exam costs more than this. What about screening testing: mammogram, Pap smears, Colonoscopy. Where will Bahamians get them done? What about Bahamians in the Family Islands?”
A senior MAB executive familiar with the NHI discussions with the Government, and speaking on condition of anonymity, suggested the Association’s next meeting with the Government - set for Saturday, January 16 - will be critical in determining its future approach.
That meeting, which will be held two days before NHI registration is due to start, is set to focus on the $212 capitation fee and the services that will/will not be included in the initial $100 million per annum primary care package.
Other issues that will be discussed, Tribune Business understands, are performance-based pay, risk adjustment, and how groups of patients with existing conditions, such as diabetes and hypertension, will be treated under NHI.
Asked whether the MAB and its members would ever withdraw all co-operation with the Government over NHI, the source said: “We hope we don’t get to that position where we don’t have to co-operate at all.
“But it is a possibility if the Government continues on the path it’s on, and doesn’t recognise we have some significant concerns with the way this is being done and the crazy numbers they keep throwing out, $212 per patient per year......
“That’s absurd. What quality of healthcare can a person get for that per year?”
The source added that, as an alternative to withdrawing all co-operation over NHI, the MAB and its members may totally reject the capitation payment method and insist they will only participate through a ‘fee-based’ system for services rendered.
“There’s no capitation; here’s what we’re willing to do,” was how they described this alternative MAB posture. “Here’s what we charge, and the various codes and consultancies we use.”
Acknowledging that the withdrawal of full co-operation by the MAB and its member doctors could effectively stymie the NHI plans, the source said the Christie administration was “banking” on private physicians who had “insufficient patient populations” signing up to the “carrot” it was dangling of 5,000 patients per year.
Tribune Business previously revealed how a Government discussion paper for a meeting with the MAB warned that Bahamian doctors who elect not to adopt the PCMH model and reject the capitation payments, will “not be eligible for additional financial benefits”.
These benefits, the document says, will include “up front” payments for PCMH doctors, plus “subsidised” medical malpractice insurance, “start-up funds” and performance-based bonuses.
Dr Sands yesterday confirmed that the NHI Secretariat and implementation team were having multiple meetings, as many as three to four per week, with various healthcare stakeholders in a bid to ensure they were on board with NHI.
Asked whether the MAB and its members might withdraw all co-operation, the former FNM senator replied: “That is the trump card that we maintain.”
Another doctor, speaking on condition of anonymity, too, agreed that the medical community was “getting to that point” of NHI non co-operation.
“We have no interest in working with them at this time,” the source added. “They’re not being forthcoming, open and honest. They’re asking for our help, but they’re not helping us.”
Another doctor said of the January 16 meeting: “We’re not interested in having another presentation; we’re interested in the nuts and bolts of how this works.”
Comments
Honestman 8 years, 10 months ago
The Doctors can and will derail NHI unless government opens up and engages in genuine consultation. The MAB has much more leverage than the Insurers and they will use it. Christie and the PLP know this and, despite the bluster, privately they must be getting concerned.
asiseeit 8 years, 10 months ago
Please, please, please put the brakes on this nation killer (NHI). I do not want to pay taxes and receive nothing. Bahamians are tired of the government stealing from them!
truetruebahamian 8 years, 10 months ago
And the People of the Bahamas should refuse to register en masse if there is no clarity forthcoming. Only after the Physicians and Private insurance agencies feel comfortable should anyone think of registering, even so - should any individual prefer private insurance only, their choice to do this should be respected and they themselves should not be penalised for having made that choice.
ohdrap4 8 years, 10 months ago
many are already registered. all who already have the chip coded card are already registered and only have to now tick boxes on a website.
ThisIsOurs 8 years, 10 months ago
212 per year? Are they serious? If that is what a 3% contribution will afford, Bahamians need to be very afraid.
ohdrap4 8 years, 10 months ago
that is the payment for the doctors and does not include labs.
Islandgirl 8 years, 10 months ago
That's for one visit hey? It can't be for more than that.
ohdrap4 8 years, 10 months ago
i go to my doctor 2-3 times a year, for the past 3 years. the visit is now 75 plus vat without health insuance, i pabout 200 for lABS
Islandgirl 8 years, 10 months ago
That's still $225 per year plus vat, and what if I needed a few extra visits one year? What then? Am I denied the visit because these dictators decided I only deserved a maximum of three visits per year? Is the doctor expected to not be paid for this? How much time does that give me with the doctor each time? Is it going to be brought to treating symptoms and not the person? We will all suffer if these ignorant individuals are allowed to get their way. perry christie is not a well man. Would his multiple health problems exceed the three visits and the allowed amount of time per visit? When/if they do, does the doc just cut the visit short and tell him his time is up? Every person is different. Like my doctor says, there is no cook book medicine. It is usually people like these jokers who try to interfere in areas they DO NOT belong. This is a democracy perry, such as it is. You are doing your utmost to turn this into a dictatorship, but I tell you what, you are excelling beyond your wildest dreams in returning this country to the fishing village it once was before Cuba closed its borders and right in time too. Cuba is opening up again to take right up where it left off and we will be left in ashes.
Islandgirl 8 years, 10 months ago
They are very serious. They obviously have no idea how things work in the medical professions and especially because of the executive level private insurances they have all been enjoying on our dime. Try that with the lawyers and see how far that goes. That's what most of these bastards are. Lawyers. They want to charge you $200 for a phone conversation yet want to give you little more than that when it comes to ensuring good quality health care and a healthy life. Doctors, you are our only hope in this. Boycott. Revolt. The country is counting on you.
Honestman 8 years, 10 months ago
Amen, Islandgirl.
B_I_D___ 8 years, 10 months ago
I still say that if NHI goes ahead that all private medical coverage for any government official or employee ceases. MP's...the PM...the lot...they are all forced to use the NHI like everyone else. No exceptions.
sealice 8 years, 10 months ago
Yeah i wanna see PGC in line with 5,000 other patients trying to get help.
sealice 8 years, 10 months ago
the truly sad part is these fools in gov't really think they are smart enough to pull something off, they believe their own VAT LIES and have transferred that "kool aid High" to NHI. They surrond themselves with stupidity to try to make themselves look better and all they do is blend in....
MonkeeDoo 8 years, 10 months ago
The doctors are the last hope to derail this. They cannot get that many Filipinos on such short notice. Probably not even in a year.
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