The Tribune

By LEANDRA ROLLE

Tribune Chief Reporter

lrolle@tribunemedia.net

NATIONAL Health Insurance providers say the programme meant to guarantee access to care is placing undue financial stress on the doctors who deliver it, as months-long payment delays and shifting government policies leave practices cash-strapped and patients caught in the middle.

Doctors participating in NHI say they have not been paid for the past two months and that the most recent disbursement covered only the final portion of October’s claims. The delays, they say, are not new, but are worsening, raising doubts about the programme’s financial stability just as the government seeks to expand benefits.

Frustrated providers have now formed the National Health Insurance Providers Association (NHIPA), saying collective action has become unavoidable as uncertainty deepens and costs rise.

“It’s unfortunate that we don't know when we will be paid, how much we will be paid,” said Dr Denotrah Archer-Cartwright, a representative of the association.

“We have rent to pay, we have utilities to pay, all of these things have gone up. We've never received any additional funds in the past seven years, yet we continue, despite not knowing and having this uncertainty of the support that we require.”

The financial strain, she said, is already reshaping care on the ground. Some doctors have exited the programme. Others, she said, are barely staying afloat, drawing on personal savings to keep their doors open.

“The financial impact is not only affecting us,” she said. “It's affecting the changes that we're seeing in the benefits for the patients, so although we hear that the plan is expanding, we also see that the benefits for the patients are being reduced.”

Providers say they are often left to explain those reductions directly to patients, a task they describe as uncomfortable and damaging to trust.

The mounting tensions come as the government has announced plans to expand NHI, including broader access to free medication. Providers, however, say no additional funding has been identified and argue that expansion without fixing payment failures risks worsening an already fragile system.

Health and Wellness Minister Dr Michael Darville acknowledged yesterday that payments are behind, confirming that while staff salaries have continued, November payments to providers remain outstanding. He said a payment was made last week, another is due next week, and that efforts are underway to regularise outstanding balances.

He said recent policy changes are part of the programme’s evolution and are intended to ensure its long-term sustainability.

That assurance has done little to calm providers, who are also pushing back against what they describe as overregulation, intrusive oversight and unilateral changes to agreements. One issue is a proposed policy that would require doctors to pay service fees to participate in NHI starting next year.

Under the proposal, providers would face monthly charges — ranging from $250 to $500 — for using the mandatory electronic medical record system.

Dr Archer-Cartwright questioned why doctors should be charged for using their own facilities, their own staff, and a system they are required to adopt.

Another provider, Dr Ian Kelly, said the approach was out of step with international norms.

“I’ve worked in a number of countries myself, and I have never seen the micromanagement that is here,” he said. “In many countries, they promote and actually encourage with extra funds. Here, we have a punitive approach to, if you don't do something, you can be affected and your income reduced.”

Dr Archer-Cartwright also criticised what she described as unilateral changes to payment schedules and patient assignments, saying providers have seen patients removed from their lists without consultation, creating confusion and disrupting operations.

“We’re just looking for transparency and respectful dialogue,” she said. “There's a deep concern that our words aren't being heard and that we are being redirected to another party.”

Dr Darville said his ministry remains committed to engagement and transparency, noting that officials have reached out to the newly formed association and are awaiting a response to continue discussions.

“Their partnership is vital to the success of the national health insurance programme, and we value the essential role they play in delivering quality care,” he said.