The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The National Health Insurance (NHI) deputy chair yesterday asserted that developing a sustainable financing mechanism is “the heart of the matter” for ensuring the scheme’s long-term viability as he urged Bahamians to look beyond delayed provider payments to the bigger picture.

Dr Robin Roberts told Tribune Business that the Government-funded and administered healthcare initiative is working “well beyond any expectations” as he vehemently rejected suggestions that NHI’s current financial strains, which have left it two months’ in arrears on compensating doctors and other providers, mean it is “collapsing” or that Bahamians will struggle to access essential care.

Asserting that such notions are “absolutely not” true, he admits in a letter published today by Tribune Business that the NHI Authority, which oversees the healthcare initiative, is facing financial challenges. But, while acknowledging that the Authority “owns” the late payments to providers, Dr Roberts pledged that it will never default on its obligations and urged frustrated doctors and other medical professionals not to undermine public confidence in the scheme and the care it offers.

He spoke out after Tribune Business recently revealed that the NHI Authority has subtly warned doctors and other providers they will continue to suffer delayed payments during the 2026-2027 fiscal year as three-quarters of the scheme’s $24.5m budget increase relates to taking on the National Drug Plan.

It wrote, in a June 24, 2026, memorandum to all physician, laboratory and other service providers, that just $6.5m of the scheme’s 2026-2027 funding increase will be used to cover existing obligations and responsibilities plus “prioritise arrears from previous fiscal periods”.

The memo used guarded, coded language to warn that Bahamian doctors and other medical professionals will likely still endure delayed compensation with payment timing dependent on when the Ministry of Finance releases the necessary funds. It conceded that these “funding constraints” will impact providers’ operations and financial status, but branded the situation as “realities” that have to be managed.

Dr Roberts, though, told this newspaper that it was only a small minority of doctors making noise about delayed NHI payments. “The sad part about it is the delays in payments are not six months or a year. It’s about a month or two months maximum,” he said. “It’s only a small portion of physicians trying to make it out to be a real big issue and it isn’t.”

However, in his letter, Dr Roberts acknowledged the payment delays but argued that their impact should not be blown out of proportion to the extent it obscures the work NHI is doing in providing improved primary healthcare access for 161,000 Bahamians or undermine public faith in the scheme.

“Much of the recent public discussion around NHI has centred on provider payments. Some of that discussion has raised legitimate questions. Some of it has reflected real frustration. But too much of it has also told only part of the story,” Dr Roberts wrote.

“That matters because when public confidence in our healthcare system is shaped by incomplete information, it is not NHI Authority that bears the greatest risk. It is the Bahamian people who depend on the programme every day.

“Let me be clear,” he added. “NHI Authority is experiencing financial pressures. We acknowledge that reality. It is an issue of timely payment, not a lack of payment. We own it. NHI will not default on its payments. We are working to address it and to advocate for sustainable solutions.

“But acknowledging a challenge should never be mistaken for admitting failure, nor should operational pressures be used to create the impression that NHI is collapsing or that beneficiaries should question whether care remains available to them. That conclusion is simply not supported by the facts. The programme remains operational. Beneficiaries continue to receive care. Providers continue to deliver services.”

NHI’s funding presently comes 100 percent from the Bahamian taxpayers via annual Budget allocations. While its budget has expanded by almost 50 percent year-over-year, from $48.2m to $72.7m, representing an increase of $24.5m, much of the latter figure relates to monies for purchasing medications. And the timing of payments, including doctor and laboratory compensation, depends on when the Ministry of Finance releases funds from the cash-strapped Public Treasury.

The revised NHI Act, passed into law under the first Davis administration, paves the way for the scheme to be financed by a mixture of employer and employee contributions, although the Government has yet to pull the trigger on this, decide the rates and how the burden will be shared. Dr Roberts signalled this is ultimately the direction NHI must take for its long-term survival and commercial viability.

“That is the heart of the matter. That is the heart of the matter; a sustainable system,” he told Tribune Business. Dr Roberts added that, back in 2021, he had participated on consultations proposing that every working Bahamian pay $1,000 per year, or $84 per month, towards NHI with this contribution split 50/50 between employer and employee.

For workers on minimum wage, their share would only be $15 per month, but he added that the proposal sought to “balance that out” by requiring all workers earning over $40,000 per year to pay 100 percent of their contributions. However, the Government did not approve the plan, which Dr Roberts said would have led to “full universal healthcare coverage” in five years - meaning by 2026.

Instead, he added that the NHI Authority focused on creating the standard health benefit (SHB) - the minimum level of primary care coverage that both NHI beneficiaries and those on private medical insurance schemes must have - and which was the central reform in the newly-passed NHI Act.

Dr Roberts, meanwhile, warns in his letter that simply throwing more money into public healthcare will not necessarily lead to better treatment outcomes. “The current conversation cannot be reduced to payment delays alone,” he explained \.

“National Health Insurance exists within a broader healthcare system that has long struggled with inefficiency, inconsistent accountability, under-utilised resources and the growing burden of chronic disease. Injecting more money into the system, without confronting those underlying issues, will not solve them. 

“Accountability for healthcare outcomes cannot rest solely with NHI Authority. Appointment availability is largely determined by providers. Utilisation patterns are influenced by providers. Referral pathways depend on provider participation. Quality standards are delivered by providers. If we are serious about improving healthcare in The Bahamas, then the conversation must be honest about the shared responsibility required to do so.”

Dr Roberts, calling on Bahamians to take more responsibility for their personal well-being, and help reduce the chronic non-communicable diseases leading to so many deaths and an over-burdened healthcare system, said: “People took on NHI right away. It’s working successfully. We have almost half the population on NHI already. No island in the Caribbean can boast that.

“NHI is working well beyond any expectations, well beyond any expectations from how quickly people have grabbed on to NHI, how they have enrolled in NHI, the physicians knocking down doors to join us and expanding into the Family Islands, realising there are good opportunities for them to go there by joining the NHI programme.

“The main issue we have now is the patients who are enrolled in NHI. We have a significant amount of patients enrolled in NHI, and they don’t go for an annual check-up. That’s where it’s important for us to educate these people that they have a responsibility, a free service that is available and they need to use it.” NHI, of course, is funded by the taxpayer.