‘Wait times will go up under NHI’

Wednesday, January 20, 2016

By KHRISNA VIRGIL

Tribune Staff Reporter

kvirgil@tribunemedia.net

LEADING surgeon Dr Duane Sands last night made a startling revelation that once the machinery of National Health Insurance is fully in motion, patients will likely face significant wait times as they seek medical attention in respective facilities, while he predicted “chaotic times” should the government move forward with its proposed healthcare scheme.

According to Dr Sands, under NHI a concept called patient centre medical homes is expected to be utilised and stipulates that for every two doctors operating at a facility, up to 5,000 patients can be registered who are not allowed to change physicians until one year has elapsed.

Dr Sands explained that when equity and accessibility are factored in under the new patient centre medical home model, “there will be significant waiting time for primary health care.” He further suggested that this could affect the quality of service to patients. This will be paid for by the government at a capitated rate of $212 per patient each year, which equates to around $1m.

However, Dr Sands suggested that this creates a financial challenge as this sum would have to be spread thinly across the operations of the facility, salaries of the medical staff and to finance the medical needs of each patient.

The outpatient primary care benefits, according to NHI draft legislation obtained by The Tribune, will consist of the services of health care providers, diagnostic, laboratory and other medical services, personal preventative services, prescription drugs and biological and health education.

President of the Medical Association of the Bahamas Dr Wesley Francis said last night this “cut and paste” approach is a point of great contention between Bahamian physicians and the government as the criteria for the model was not practical.

However, Dr Delon Brennen, NHI’s project manager said the proposed criteria for the patient centre medical homes was a work in progress.

In the primary care phase of NHI, the projected cost for it is estimated at just over $100 million for the first of the services to be delivered, Dr Brennen said.

As it stands the government currently spends around $400 million providing healthcare to the citizens of the Bahamas. When private sector spending is factored in, nearly $800 million is spent.

The doctors, with President of the Bahamas Insurance Brokers Association Felicia Knowles, were the panelists at a Bahamas Pan-Hellenic Council NHI town hall meeting in the Harry C Moore Library of the College of the Bahamas. It saw scores of curious Bahamians packed into the room who fielded questions about NHI.

“That patient centred medical home will then be responsible for the maintenance and preventative care for those patients that are signed up for one year. So if you sign up with a patient centred medical home you cannot change physicians except at the anniversary of your enrolment,” Dr Sands explained.

“When you go to see the doctor for out patient services like high blood pressure diabetes, etc, you go into the doctor and if the patient centred medical home is a part of NHI you will be seen, you will be examined and so on and so forth. But there is no payment due. If that physician determines that you require certain covered blood work or basic x-ray studies or basic lab tests they will not only be done, but they will be paid for by the practice.”

He continued: “Now the challenge is if you have 5,000 patients in a practice with two doctors and you look at the number of visits from 8am to 5pm, five days a week it basically works out to three 15 minute visits per patient per year. Now the assumption is that if you look at the number of visits that people actually have now it’s only about 1.7 visits per person per year.

“The issue, however, is these are doctors that are going to be churning patients out left right and centre. In the patient centred home you also have nurses and an administrator.

“The government proposes that in exchange for this service that they will pay these patient centred medical homes on the basis of a capitated rate, which means that for every patient in your practice the doctor at the practice will get $212 per year.

“Now that sounds like a lot of money. You do the arithmetic 5,000 times $212 is a million dollars. There are many doctors in this town who have never seen that kind of money so they are dangling this carrot as if it is big money.

“The reality is that that includes payment for the doctors, payment for the nurses, payment for the administrator, payment for the lab tests, payment for your records, etc. Now the question is given the fact that this is going to go live in April and you don’t have any regulatory framework what is going to happen?”

In response, Dr Francis said the medical home concept is something that the physician community has “real difficulty” with.

“About 90 per cent of qualified general practice specialists would not qualify for that and this is why it is a big contention. We have to understand what quality is about and that is one of the issues that the association has because you have to define what quality care is about. This concept has its benefits but it’s coming from more resource rich countries. It is a cut and paste approach, but it is not practical.”

The Christie administration plans to roll out a primary healthcare package for NHI in April and a vital healthcare benefits package sometime within the next year.

Comments

Chucky says...

So we now know that since the doctors pay must come out of the gross monies collected, these doctors will have incentives to perform the very least care possible and the fewest tests possible. Their survival depend on it, and Its just human nature, well and greed.

Just imagine a small clinic , towards the end of the year, the doctors and staff will have to consider weather they eat, or treat patients. And the patients, some who will now be experiencing "free care" , well they'll be rushing to the doctor every time someone gets a boo boo.

At best , doctors could be paid per patient visit, and costs of procedure be covered directly by government. Otherwise, care offered will be based purely on doctors trying to keep as much money as they can

Disgusting, concocted deal!

Posted 20 January 2016, 12:49 p.m. Suggest removal

TalRussell says...

Comrades I am pro immediate introduction BahamaCARE but I need strong evidence
why government thinks it needs force those covered under BahamaCARE, not always remain the "sole deciders" over which doctor(s) they seek out for medical treatment. It doesn't seem make for any explainable cost savings economic sense.
Isn't this contrary behind the purpose for walk-in clinics?
How will this restriction apply to the thousands who live on our medically under-serviced out islands where there are no stationary medical doctors, and who often travel for medical treatment at the very last moment?
What happens if I want seek-out a second medical opinion?

Posted 20 January 2016, 1:55 p.m. Suggest removal

TruePeople says...

for the second opinion go to the States... their opinion will probably be more accurate anyway

Posted 20 January 2016, 3:25 p.m. Suggest removal

Comrade if 60% of Bahamalnders living in Nassau & Freeport do not hold a valid passport It's anyone's guess the numbers living on our out islands?
What people don't want or need is to jump from the restrictive workplace insurance plans to an equally restrictive BahamaCARE.
Government MUST make BahamaCare's tools user friendly from the get go.
The planners must reserve their time and energies to deal with the many challenges they will need to constantly tweak of which any country must face when introducing Universal Health Care. And, many they will encounter, so no need create them.

Posted 20 January 2016, 3:53 p.m. Suggest removal

GrassRoot says...

who pays for the airfare from Outislands to New Providence under NHI?

Posted 20 January 2016, 7:05 p.m. Suggest removal

hey TalRussell, the evidence is all around you, look at all the corruption, blatant stealing by these government thieves. Thats the evidence. And as you know poor can't really contribute, and the better off have private medical. They need those who can pay, to pay, or there is nothing to steal.

How can you be for this or support this in any fashion? A $212.00 budget per patient to cover care, test , staff, doctors, light bills etc, doesn't take more than 2 seconds of thought to see that under this structure , doctors will have an incentive not to provide any service at all. $212.00 will be eaten up in the first visit and first test the doctor sends out. This is the wrong structure for government healthcare.

Posted 20 January 2016, 6:30 p.m. Suggest removal

Fear not for the doctors welfare's my dear Comrade Chucky. Under socialized medicine your doctor friends will not see their wealth status hampered, hindered in any manner, form or fashion.
There will not be no welfare bake sales held anywhere in Bahamaland for doctors that will be attributed back to BahamaCARE - unlike the way monies have been raised for hundreds years for so many thousands very ill man's. woman's, boys and girl's.
Several I years back I personally was approached and contributed to a medical fund for the seriously ill, dearly beloved father of a senior then senior branch manage at the Royal Bank of Canada.
It has affected all from many walks life.
What about all the policy holders of the failed CLICO Insurance?

Posted 20 January 2016, 6:52 p.m. Suggest removal

well, why then are there no doctors in the family islands?

Posted 20 January 2016, 7:06 p.m. Suggest removal

Comrade because our Government didn't make it a requirement of licensing to spend a few years in island practice.

Posted 20 January 2016, 7:09 p.m. Suggest removal

DEDDIE says...

I don't know what the big deal is. Primary care already exists. Children up to the age of eighteen and the elderly already have primary care. Those two grouping are our biggest health care expense. All those in between pay a small amount for service render by the public health care system with the Government subsidizing the bulk of the cost. The government is selling something that already exist. What we need is catastrophic care.

Posted 20 January 2016, 2:58 p.m. Suggest removal

EnoughIsEnough says...

i think they need to factor into the percentage paid for how many members in a family are dependents. for example, i have no kids - so why should i pay the same amount as someone making the same salary as me but who has 3 kids or 5 kids? And why should i or anyone pay NHI for people who are unemployed and have countless kids for men who do not bear financial responsibility? Plus, I pay my own private insurance? We are not a socialist country. I think before we start providing even more free health and everything else free to people we need to make people accountable. If you can't afford kids, don't have them - don't expect me and other hardworking taxpayers to have to pay for your damn kids - their medical, their education (or lack thereof, etc. I am not talking about hardworking families who fall upon hard times, i'm referring to the ridiculous number of women who continue to have kids without having any means of support. They become a huge burden on society and we are a failing country. i'm tired of paying for these people - through duty, through VAT, now through NHI. enough is enough!

Posted 20 January 2016, 4:24 p.m. Suggest removal

Here's how it premiums should work:

Posted 20 January 2016, 9 p.m. Suggest removal

sheeprunner12 says...

The above comments are very troubling but true ............ there are very few Bahamian professionals who are willing to relocate to the Family Islands ........ it is hard to find teachers, doctors, accountants, pastors, dentists, vets, etc where it is not economically viable ......... even "island people" who go off to school do not want to return to their home islands to help build them ........... just remember what Fitzgerald said about Inagua's teacher shortage

Posted 20 January 2016, 7:40 p.m. Suggest removal