The Tribune

By ANNELIA NIXON

Tribune Business Reporter

anixon@tribunemedia.net

Bahamian doctors yesterday challenged assertions by the National Health Insurance (NHI) Authority’s deputy chairman that only a minority are complaining about delayed reimbursement as they revealed an Association has now been formed to negotiate with the scheme.

Doctors who care for the Government-run healthcare scheme’s patients confirmed the Provider Physicians Association has officially been registered, and will now seek recognition as the negotiating body for NHI providers.

Dr Denotrah Archer-Cartwright, its president, reiterated that chronic payment delays and a lack of transparency are threatening the sustainability of smaller medical practices. She said the Association was created to give doctors a collective voice after repeated concerns over delayed reimbursements failed to produce meaningful change.

“Our association is now registered,” she said. “We are officially a physician’s union, and we will be moving to be recognised as the negotiating body moving forward for the NHI physicians and looking to empower physicians so that they can speak out.”

Her comments came after NHI deputy chair, Dr Robin Roberts, argued that the programme’s financial pressures should not overshadow what he described as a healthcare initiative performing “well beyond any expectations”.

While acknowledging the Authority is running one to two months behind on provider payments, he argued that only “a small portion” of physicians were making the issue appear larger than it is and pledged NHI would never default on its obligations.

Dr Archer-Cartwright strongly rejected that assessment, adding: “There has been a level of exploitation of physicians for some time. To say that only a small amount of people have an issue with not being paid is a really odd thing to say.

“So, every month being two months or more behind is supposed to be acceptable? Here lies our problem, because he’s a Board member, and he thinks it’s acceptable to not pay someone for two months.”

Dr Archer-Cartwright argued that the issue extends beyond physicians themselves, as their practices must continue meeting payroll, rent and other operating expenses regardless of whether NHI reimbursements arrive on time.

“When does it become a problem when people have to pay their staff every month?” she said. “They have to pay their bills every month, and they’re always two months or more in arrears. Why is that acceptable?” 

The Association has expanded from roughly 40 to 50 physicians during its formation to about 60 members, according to Dr Archer-Cartwright, although she explained it ultimately had to be registered as a union of employers rather than employees because private physicians operate independent practices. She said the organisation primarily represents smaller providers that are bearing the greatest financial strain.

“We are really the smaller providers,” she said. “Maybe some of the large practices or the franchises are OK with this, but who is feeling the brunt of it? We’re almost like the underdog. We’re the one or two or three doctor practices that have made the system run.”

Dr Archer-Cartwright said physicians are seeking a more sustainable process for the NHI programme that includes on-time payments. She argued the focus should not be on how many physicians are voicing concerns publicly.

“The focus shouldn’t be the number of doctors,” she said. “The focus should be: Are you paying the doctors on time? The answer is no. Are you being completely transparent? The answer is no.”

Dr Archer-Cartwright also suggested payment delays have forced some physicians to reduce their dependence on NHI patients or abandon independent practice altogether.

“I would say some people have maybe cut down, and some people have had to close their practice and go and work for another position or larger group practice,” she said. “Maybe they had to leave their practice because they couldn’t sustain it.”

“We’re here as an organisation to empower physicians and give us the ability to negotiate something that is fair. We hope that the NHI Authority and the Ministry of Health and the Government would appreciate physicians wanting to amicably participate in the future of healthcare.”

Her position was echoed by Dr Ian Kelly, who dismissed suggestions that dissatisfaction was confined to a handful of providers. “It’s not true that it’s only a few people,” he said.

Dr Arlington Lightbourne, founder and chief executive of Bahamas Wellness, said the issue was less about whether payments are delayed than whether providers can reliably predict when they will be paid.

“It’s going to be a matter of individual case-by-case circumstances,” he said. “Everybody’s cash flow situations are different. Two months may be fine for one provider, and obviously for another may be a challenge.”

He added that NHI contracts were originally structured around monthly payments, and argued physicians are entitled to expect those terms to be honoured.“There has been no change in that relationship or change in that contract, and so I think physicians have every right to expect their monies to be paid on time,” Dr Lightbourne said.

While describing himself as “a major supporter of NHI”, he said providers’ concerns are legitimate. “I agree with Dr Roberts’ perspective that we cannot undermine the integrity of the programme,” Dr Lightbourne said. “But I also believe that physicians are justified in having concerns.”

Although only a handful of doctors may be speaking publicly, he added: “A significant percentage of the NHI physician population are in fact disappointed, and are anxious over receiving payments in a more timely manner.”

Dr Lightbourne said the Authority has kept providers informed when payments are delayed, but argued uncertainty over timing makes financial planning difficult. “My issue is the unpredictability of it,” he said. “If I know that my receivable is going to be 60 days, then I can plan for that. But if I don’t know when I’m going to be paid, I can’t plan. I can’t run my business.”

Rather than demanding immediate payment, Dr Lightbourne said physicians need certainty. “If we’re now saying on average you can expect money 45 days after the due date, then let’s put that in writing so we can plan for that.”

He stressed that most physicians continue to support the national healthcare initiative despite their frustrations.

“Most physicians support NHI and what it’s trying to do, and certainly I do,” Dr Lightbourne said. “I do not want, nor would I ever, put out anything that would disparage NHI or make it seem like it’s not working… All I’m saying is that we need more predictability in when funds are going to be paid.”