The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The National Health Insurance (NHI) scheme has subtly warned doctors and other providers they will continue to suffer delayed payments during the upcoming fiscal year as three-quarters of the $24.5m budget increase relates to taking on the National Drug Plan.

The NHI Authority, in a June 24, 2026, memorandum to all physician, laboratory and other service providers, revealed 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, which has been obtained by Tribune Business, 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.

The Authority, which oversees and administers a scheme providing healthcare to more than 161,000 Bahamians annually, said payments to doctors and other providers now consume 86 percent of its annual budget. However, physicians spoken to by this newspaper described this as potentially misleading, arguing that this number has resulted from increased volume - continually adding more providers to NHI - rather than higher payment rates which have not increased in a decade.

Dr Denotrah Archer-Cartwright, a leading voice among NHI providers, also branded the Government’s touting of NHI’s expanded 2026-2027 budget as misleading on the basis that much of the increase represents a “reallocation”, rather than additional funds, due to the incorporation of the National Prescription Drug Plan (NPDP) with effect from the upcoming fiscal year.

The Drug Plan, which had long resided within the National Insurance Board (NIB), was transferred to the Ministry of Health and Wellness prior to reaching its final destination - NHI. While the latter’s 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.

“The Government of The Bahamas has allocated $72.7m to the NHI Authority for fiscal year 2026–2027, beginning July 1, 2026, reflecting its continued national commitment to healthcare access and service delivery,” the Authority has told providers.

“Eighteen million dollars has been allocated for the National Prescription Drug Plan (NPDP), primarily to support the cost of medications under the programme. [And] $6.5m represents the increase to the NHI programme funding to support the program’s responsibilities, expanded operational costs and prioritisation of arrears from previous fiscal periods.”

As a result, when added to the prior fiscal year’s $48.2m budget, the NHI Authority asserted that “$54.7m is designated to support existing programmes, healthcare operations and service delivery”. This means, in practice, that just one-quarter or a little over 25 percent of the Authority’s budget increase is geared towards the present scheme.

“It’s not a budget increase; it’s a reallocation of funds,” Dr Archer-Cartwright told Tribune Business. “That money [$18m] used to be under the NIB programme. That money is now being reallocated to NHI. That’s not an increase to the NHI system. They have taken on more, which is how they have managed NHI. Now they have taken on the Prescription Drug Plan, they have reallocated funds and money that they clearly were going to spend.”

The NHI Authority, meanwhile, warned that despite the seemingly large budget increase it will persist with the frugal approach to financial management it has adopted in past years. “As experienced in prior fiscal periods, careful allocation and prioritisation of available funding will continue,” it declared.

“To ensure the programme’s sustainability and continuity of care, the Board of Directors has directed a disciplined financial and operational approach for fiscal 2026–2027 grounded in prudent resource management and responsible governance.”

The Authority added: “Over time, provider payments have continued to increase and now account for approximately 86 percent of NHI Authority’s total budget allocation.

”Within this framework, provider payments will continue to be issued as government subventions are disbursed to the Authority. NHI Authority acknowledges the operational impact that funding constraints and payment timing may have on providers and remains committed to working collaboratively to manage these realities.

“At this time, no substantive changes to provider reimbursement models are being introduced. The Authority will continue to closely monitor programme performance and expenditure trends to ensure alignment with available resources to guide reforms and operational efficiencies as needed during the upcoming fiscal period.”

Seeking to end on a positive note, the Authority concluded: “The Board of Directors and executives will continue to advocate for sustainable funding mechanisms to support the long-term viability of the NHI Authority and the ongoing delivery of healthcare services to the Bahamian people. NHI Authority remains committed to transparent communication and ongoing collaboration with providers.”

Dr Ian Kelly, an NHI doctor, told Tribune Business that the reference to 86 percent of the Authority’s budget being consumed by compensation payments was misleading as this is being driven by the expansion of provider numbers rather than any rate increase despite inflation having risen by at least 30 percent since the scheme started in 2016.

Both he and Dr Archer-Cartwright argued that NHI’s sustainability is being undermined by the constant push to expand the scheme rather than ensure there is sufficient financing in place to support what already exists. “There has been no increase for me since 2016,” Dr Kelly said. “That [86 percent figure] doesn’t meant we’ve received any more. It means there are more doctor providers or people enrolled in it.”

He added that his practice is still receiving the same $12.50 per patient, per month capitation rate that providers were paid when the present NHI model was first launched in 2016 despite expenses increasing substantially since then due to the cost of living crisis.

Dr Archer-Cartwright, meanwhile, said the NHI Authority’s memorandum had merely reinforced doctor concerns that the scheme’s current model is unsustainable without increased funding amid the constant drive for growth in both patients and providers.

And she asserted that the “fiscal discipline” mentioned in the note refers to NHI “taxing the physicians” by charging fees for registration, the use of doctors’ own facilities and $300 per month to access the scheme’s electronic medical records. Dr Archer-Cartwright also said the Authority is frequently switching patients between doctors, moving them from practice to practice.

“Their idea of discipline is they are going to tax the physicians, make the providers pay for the programme,” she argued. “I hear them talk of expanding catastrophic care, and expanding facilities. We are going to be right back to where we are in in six months’ time if they continue to expand the programme and refuse to take input from the providers.

“What they are doing is just adding more and more providers, expanding the programme to other places and the Family Islands when they couldn’t afford what they are doing now. They have accelerated growth without sustaining what they have. It’s very frustrating because there is no action to adjust. For some reason, they think they have a good model of doing things. They don’t seem to respect the physicians.”

Footnote

Compensate - Page XX

Headline

Physicians: NHI ‘accelerating’ but

not sustaining existing scheme