The Tribune

By LEANDRA ROLLE

Tribune Chief Reporter

lrolle@tribunemedia.net

NATIONAL Health Insurance providers are once again raising alarm over delayed payments, calling for details on how funds budgeted for the programme are being spent.

Representatives say payments are now two months overdue and that the most recent disbursement covered only half of what is owe, a routine shortfall that has persisted for nearly two years.

“Where are the budgeted funds going?” said Dr Denotrah Archer-Cartwright while appearing as a guest on the Guardian’s Morning Blend yesterday. “Because some months we don't have a payment, all right, and they struggle to even do a half payment.”

Her remarks are the latest sign of doctors’ growing frustration with the programme as concerns about its financial stability mount.

She said some doctors have quietly left the programme, while others have been forced to scale back services due to the financial strain.

“Doctors have dropped out quietly, laboratories have dropped out quietly, but they're still expanding the programme. This is the thing that we don't understand,” she said. “If you're saying you're having an issue with cash flow, why would you be expanding?”

Doctors in NHI are paid through capitation and do not submit individual billing claims, while laboratory providers invoice through a separate system.

Dr Ian Kelly, another provider, said doctors are paid $12.50 per patient in their group, while Dr Archer-Cartwright noted the rate can start as low as $6.

“It only works if the system was working, and the way that it was sold to us is that we will provide consistency and transparency for you taking a tiny, tiny, tiny aliquot of funds to see these patients,” she said.

Dr Kelly, meanwhile, said providers have received no payment increases since 2017, even as the cost of living has risen by more than 30 percent.

“So it's completely dysfunctional for a start, it's completely dishonest, and it downgrades us as professionals. It makes it easier to develop burnout, because you realise you're being disrespected by the people who are in charge and we have no say,” he added.

Government officials have blamed payment delays in part on problems with laboratory claims and weak pre-clearance controls.

Health Minister Dr Michael Darville said earlier this year that irregularities sometimes emerge in how claims are calculated and argued the system needs tighter, more efficient processing.

Still, he said work is continuing to make the process more efficient and ensure claims move through the system in a more structured way.

Meanwhile, frustrated providers have formed an association to highlight their concerns but say they are still waiting to be officially registered after being asked in January to change its name.