PMH fee increases are 'not so simple'


Tribune Business Reporter

A Cabinet minister yesterday admitted that the plan to implement up to 500 potential fee increases at the Princess Margaret Hospital (PMH) was "not as simple as it may seem".

Dr Duane Sands, minister of health, told Tribune Business that the Government would not accomplish its revenue targets if the fees fail to capture more than the 13 percent of persons currently paying for services at PMH.

Speaking with Tribune Business ahead of a Cabinet meeting yesterday, Dr Sands said: "We have presented it to the PHA board and the PHA management to verify that we can now go ahead and institute the new fee schedule. Again, it's a matter of making sure the policy isn't a matter we have to institute and then backtrack on.

"There are agreements which say you can't do this and shouldn't do that. There are union agreements which say you shouldn't pay if you go for services in the public hospital. Those agreements, bear in mind, were created at a time when many civil servants did not have major medical insurance paid for by the people of The Bahamas."

The Government had previously said it would implement the fees to generate increased revenue for the beleaguered state-run hospital. Dr Sands added yesterday: "I have said repeatedly that 87 per cent of people who use services in our healthcare system don't pay anything.

"It's all well and good to change the fee schedule, but if you're still only getting 13 per cent of persons paying the fees it's not going to accomplish what you want. We are going to have to, in some cases, legislatively modify the approach and in other cases change some of the contractual agreements, some of the union agreements and so on. That process is not as simple as it may seem."

Dr Sands said that the proposed morgue fee increases had represented what he described as a "false start" to the fee schedule implementation. Late last year, funeral directors protested against the proposed fee hikes, which including the handling of remains, storage and new taxes for autopsies.

"We have identified what we would like the fees to be, and there was a false start with the morgue fees, bearing in mind that there was never any sign off from the Minister or Ministry of Health. As a result, that had to be rescinded," said Dr Sands, who has previously noted that the Public Hospitals Authority (PHA) Act allows the body to retain earnings from various fees which were gazetted many years ago but have not been collected.

Dr Sands said: "In the process of determining when we could sign off on the fee schedule, we realised that these fees are tied in to some complicated agreements and we need to make sure that someone can't say: 'Look, here is an agreement that says my people will categorically not pay'.

"I'm a politician and I have health insurance paid for by the people of The Bahamas. I can also get free care at the Princess Margaret Hospital, but why should I get free care when I have health insurance paid for and that money can be used to benefit the hospital as opposed to Cleveland Clinic, Jackson Memorial and other places."

He added: "While it may seem straightforward, union A or B may say that they are not prepared to have their members pay anything. I'm not saying that they have, because it hasn't been put to them in that way, but each union that has an agreement, we're going to have to look at it, see what the language is and determine whether it is something that can be changed unilaterally, or whether it requires a specific conversation.

"It makes no sense if we say that we have a $40 million deficit and, right as our hospital system is suffering, we are paying $85 million in health insurance to the benefit of every other hospital in the world. If the hospital is prepared to accept just the payment of the insurance, and the PHA agrees to pay the co-pay, that seems like a win-win solution. All of this has to be carefully negotiated, thought out and planned. We have already conceptualised it, now we have to implement it."

Dr Sands also underscored the importance of generating electronic medical bills. "We don't have the capacity to generate electronic bills. Everything is hand written, and so if you are going to increase revenue you need to generate bills that are validated and have the supporting documentation," he explained.

"That may seem simple, but imagine if you have 55,000 people into the emergency room and 100,000 to the outpatient clinics, and many thousands coming in as inpatients. We don't have the capacity right now, and we don't because it was never considered important."