• Health scheme targets ‘efficiencies’ due to ‘finite resources’

• Ex-minister says Authority being forced to ‘ration services’

• Adds it exposes ‘worst kept secret’ of Gov’t cash flow woe

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Bahamians will now have to endure an extra 90-day wait to enroll in National Health Insurance (NHI) as the scheme embarks on an efficiency drive to counter its “finite resources” this fiscal year.

Christy Butler, NHI’s managing director and chief executive, unveiled the move as part of a package of changes announced in a November 2, 2023, letter that several medical sources - speaking on condition of anonymity - said amounted to “managing the capacity” of the scheme to cover an ever-increasing number of Bahamians and fit this growth into a limited budget.

However, Dr Duane Sands, the FNM’s chairman and a physician himself, said Mrs Butler’s letter was using “high falutin” language to explain that NHI is effectively “rationing the services” it provides to the Bahamian people. This comes after doctors and other NHI providers were paid late for services rendered during their October pay period.

Dr Sands, meanwhile, argued that NHI’s late October payment further exposed “the worst kept secret”, which he described as the Government’s “cash flow problems” that have resulted in a wide variety of vendors, service providers and other beneficiaries suffering undue delays in collecting on outstanding bills that are due and owing. 

Neither Michael Halkitis, minister of economic affairs, nor Dr Michael Darville, minister of health, responded to Tribune Business phone calls and messaged inquiries before press time last night. However, Dr Sands said the woes extend beyond NHI, adding that he “knows for a fact” that several Bahamian students and their families are “in deep trouble” because scholarship commitments have not been met on time.

The FNM chairman, though, asserted that he has “seen with my own eyes” how taxpayer monies are being pumped into the West End and Bimini constituency ahead of the upcoming by-election. Besides filling in all the road pot holes in Eight Mile Rock and Holmes Rock, he added that Bimini’s clinic, which was “sorely in need” of an upgrade when he arrived last Wednesday, has now been painted.

Mrs Butler, in a letter obtained by Tribune Business, while apologising for the late October payments to NHI providers, also disclosed several administrative and management reforms that will be implemented during the current fiscal year which runs until end-June 2024.

These include the extra 90-day enrollment period, which is being added to the existing “standard” time for Bahamians to be on-boarded to NHI. Mrs Butler explained that this will mean someone who enrolls with NHI on or after November 22, 2023, will have to wait until April 2024 to fully join. Existing NHI beneficiaries will not be impacted.

“New beneficiaries will now receive an enrollment date of 90 days plus the standard enrollment period,” she wrote. “For example, a beneficiary that enrolls on or before November 21, 2023, will receive a March 2024 enrollment date, and a beneficiary that enrolls on or after November 22, 2023, will receive an April 2024 enrollment date. Reassignment of current beneficiaries will not be impacted.”

Other “efficiencies” that NHI is now seeking will come from a push to “verify” its existing beneficiaries. This is intended to ensure its healthcare services are only being provided to Bahamians properly enrolled with the scheme.

“Verifying beneficiaries’ contact information is crucial to ensure services are provided to enrolled individuals. Accurate beneficiary information also facilitates effective communication and co-ordination of care, ensuring that beneficiaries can access healthcare services and support as needed,” Mrs Butler said.

She also indicated that there will be limits on how many new medical providers become part of the NHI network, describing this as “capacity management”. Mrs Butler said: “By only onboarding providers to meet population needs for services, we ensure adequate access to healthcare services as we continue to address the demand throughout The Bahamas.”

The use of laboratory services will also be managed, with NHI’s top executive writing: “Implementing clinical guidelines and laboratory utilisation reporting allows the authority to make informed decisions.”

Dr Sands, though, argued that Mrs Butler’s letter amounted to a fancy way of signalling that there are limits on the amount of healthcare services NHI can provide. “That is a high falutin way of rationing services,” he told Tribune Business of the 90-day enrollment period extension.

“Out of one side of the Government’s mouth, NHI is to provide universal primary care. Out of the other side of their pockets, they have clamped down on the financial spend to finance their rhetoric. They don’t want to move away from the rhetoric or talking about catastrophic care, and don’t say where the money is coming from.

“It’s absolutely revealing. It speaks to the fact that the worst kept secret is this government is having cash flow problems. Healthcare providers across the board are finding monies are not following. When we look at medical supply companies, I’m advised some of them had not been paid since August for various and sundry supplies to the healthcare sector.”

The NHI Authority, which oversees the national healthcare scheme, is due to receive a $46.2m taxpayer subsidy from the Government this fiscal year to finance its activities. “That’s the only place where it can come from,” Dr Sands, a former health minister, said of NHI’s financing. “I don’t think the NHI Authority will be late. The only place they get money from is the Government. The fact they’re late tells volumes.”

Doctors who provide services to NHI and its beneficiaries, speaking on condition of anonymity, yesterday confirmed they have been informed by the NHI Authority that October payments were late due to delays in it receiving the necessary disbursements from the Government.

“There have been delays on the physician side, and also on the laboratory side,” one said. “As far as I’m aware, they did catch back up. It was because of the funding from the Government; the disbursement of finds from the central government to the NHI Authority.”

E-mails and documents seen by Tribune Business show that NHI providers were first alerted on October 13 that the month’s payment, due on the 15th, would be delayed. “Please be informed that unforeseen circumstances have led to a delay in the processing of capitation and laboratory payments for this month’s October 15th pay period,” wrote Gabrielle Bastian, NHI’s primary care provider and strategy manager.

“Therefore, it is anticipated that funds will not be disbursed as scheduled. An update will be provided by end of business on Monday, October 16. Thank you for your patience and understanding. We apologise for this payment delay and for any inconvenience it may cause. We greatly value your hard work and efforts on behalf of the Authority.”

This was followed by an October 16 e-mail from Ms Basden in which she said NHI was “working diligently to complete the payments to providers”. A further follow-up, dated October 19, promised that 60 percent of what was due would be paid the following day.

“As we continue to work towards a resolution, the Authority will release 60 percent of payments to all providers tomorrow, Friday, October 20,” Ms Bastian said.  “We recognise the inconvenience that the delay and partial payment have caused, and we are working assiduously to release the remaining 40 percent to complete the payments for this pay period.”

The outstanding balance was paid on November 2, some 18 days late. “Today, the remaining 40 percent payment for the October pay period was released. The NHI Authority sincerely apologises for the recent delays in payment; we take our commitment to providing payments as scheduled very seriously,” Mrs Butler wrote.

“Despite overwhelming public support, enrollment growth and dedicated efforts, the NHI resources have remained finite within this fiscal period. However, our resources will continue to be managed effectively and efficiently.

“With the increasing interest among providers and beneficiaries, the ongoing implementation of public health management interventions is imperative to achieve the goals and mission of NHI and further support the programme,” she added.

“This will be accomplished through critical partnerships with programme stakeholders, ongoing collaboration, communication, service commitments and innovation. Therefore, the authority will continue implementing programme efficiencies throughout the fiscal year July 1, 2023, to June 30, 2024.”

Dr Sands, though, yesterday argued NHI’s difficulties were a symptom of the Government’s wider cash flow issues and ability to meet its payables on time. “We’ve seen a deterioration in the Government’s paying culture or paying behaviour,” he argued. “That’s across scholarship grants, NHI providers, temporary workers.

“Each different agency comes up with their different excuses; we had a glitch with the software and will make sure you get paid. I’m not sure I believe that. Fundamentally, it’s a problem with cash flow....I have also heard that a number of students entitled to scholarship subventions that they have not been paid. I can verify with personal knowledge that is the case. Those are students on international scholarships.

“Certainly it appears there is an issue with payables and cash flow. The Government has been very defensive on this point. For students, contract workers it’s been devastating. There are a people facing serious hardship because of it,” Dr Sands continued.

“There are families in deep trouble because children had to leave school because the Government has not made good on its commitment to pay scholarships. I know that for a fact. That’s not speculation or something that I’ve heard. I would not make such a strong statement if I could not attest from personal information, certainly on the scholarship issue, that scholarships are not being paid.”

Mr Halkitis denied the existence of any government cash flow woes when the Opposition raised the issue in September and accused the Free National Movement (FNM) of “preaching gloom and doom” for political purposes. He also asserted that the Government is meeting all its obligations, is not broke and is paying all its bills in the ordinary course of business as soon as they can be verified.

Dr Sands, though, said the Government appeared to have little difficulty finding funds for West End and Bimini ahead of the upcoming by-election. “I arrived on Wednesday,” he added of Bimini. “The clinic there was really run down and decrepit, and badly in need of a paint job. It has been painted as of today [Monday]. You wonder how, all of a sudden, this became a priority.

“They can certainly find money to have a contractor paint the clinic in Bimini and fill in the potholes in the roads. That has happened in Eight Mile Rock and Holmes Rock. I’ve seen that with my own eyes in the last three weeks. They can find money when they want to find money.”

Dr Sands said the Government’s cash flow woes also explained why it has embarked on “the deep dive into revenue capture by increasingly draconian measures” involving the garnishing of bank accounts, which he argued has impacted the ability of Bahamians to pay food, light and other bills. He added that the Government is demanding taxpayers settle their debts in timely fashion but failing to do the same itself.