By ANNELIA NIXON

anixon@tribunemedia.net

A National Health Insurance (NHI) provider yesterday said she understood why the Government has moved to impose “caps and limits” on the scheme’s laboratory benefits package.

Dr Burnell Cardron, at Pompey Medical, agreed that the measures are necessary to contain escalating laboratory costs. “We have over 160,000 Bahamians and residents enrolled in the programme now, and in order for them to be able to gauge or see their expenditures with regards to laboratory services, I think it’s a necessary implementation for the programme to be sustainable,” she said.

Dr Duane Sands, the Free National Movement (FNM) chairman, told this newspaper that he “cannot see how they could not have put the brakes on this runaway train” but Dr Cardron says she does not quite agree with him.

“You know, we don’t order blood work haphazardly just because, or just order a whole array of blood work just because they kind of dive side by side their criteria, restrictions, which is understandable because you want to be able to engage your spending and you want to be able to, you know, be able to measure at least what you’re doing,” she explained.

Dr Cardron said NHI tends to keep providers updated. She expects the scheme to let providers know if there are any changes. “So as far as I would say, I think that the programme is going somewhat smoothly now because they are energised, they are putting in the necessary capitations and limits so that it doesn’t just go haywire. People aren’t just ordering things at random just because,” she added.

Tribune Business revealed that NHI is set to impose “caps and limits” on a portion of the care benefits received by 160,000 Bahamians as part of further “cost containment measures”.

The Government healthcare plan’s governing authority, in a notice sent to the scheme’s providers, said the restrictions to laboratory benefits will be introduced in October 2024 and help to “better manage.... escalating costs”.

The notice also revealed that limitations will be maintained on the size of NHI’s care network, and the number of doctors, laboratories and other medical facilities offering services to patients enrolled in the scheme, with no new providers set to be added on New Providence before the 2024-2025 fiscal year ends next June 30.

Payments for laboratory services will now be made at month’s end on the 30th, instead of the 15th, from September onwards while the 90-day wait that all new patients - apart from expectant and new mothers, as well as infants - must endure before they can join NHI remains in place.

Dr Michael Darville, minister of health and wellness, in a messaged reply to Tribune Business inquiries confirmed that the notice from the NHI Authority was genuine and defended the measures as “prudent” to “ensure the continued sustainability and effectiveness” of the scheme.

“Due to the Government of The Bahamas’ broader fiscal management priorities, and to ensure the programme’s sustainability, the NHI Authority Board of Directors has directed the following cost containment measures in its fiscal 2024-2025 Budget allocation,” the NHI Authority Board warned.

“Starting in October 2024, the NHI Authority will introduce caps and limits to the laboratory benefits package to better manage escalating laboratory costs. Awareness campaigns will be launched to inform beneficiaries, providers and the public about these new measures.

“Expansion of the provider network throughout the archipelago will be guided by resource and capacity management considerations. No new providers will be onboarded in New Providence during the fiscal year 2024-2025.”

Confirming other more minor adjustments, as well as the continuing 90-day wait before most new patient applicants are admitted to NHI, the NHI Authority Board added: “As of September 2024, the payment schedule for laboratory reimbursements will be adjusted to the 30th of each month. Capitation and bundled payments will continue to be reimbursed on the 15th of each month....

“The 90-day enrollment timeline for new beneficiaries will remain in place, except for maternity and infant beneficiaries, who will receive the previous standard processing timelines.” The changes, especially the laboratory benefits “caps and limits”, could affect up to 40 percent or four out of every ten Bahamians based on a 400,000-strong population.

Defending the measures, and seeking to explain the rationale for their implementation, the NHI Authority Board also warned that further cutbacks and restrictions may become necessary. It added: “Since its launch in 2017, the NHI programme has become a Bahamian success story, exceeding expectations and pioneering a transformative approach to healthcare delivery.

“The programme has successfully enrolled over 160,000 Bahamians and residents, and provided them access to essential healthcare services. It has also significantly improved health outcomes nationwide, ultimately contributing to increased life expectancy and reduced healthcare disparities.....

“These changes have been carefully and thoughtfully considered to serve the best interests of all stakeholders. The NHI Authority Board of Directors and executives are committed to responsible governance, which necessitates the implementation of these operational and programme reforms,” it continued.

“Our provider network and the Bahamian public deserve a programme that operates efficiently while maximising resources. As we continuously assess the performance of the NHI Authority programme during the fiscal year, if additional measures become necessary we will communicate them directly to you, our valued stakeholders.”

The NHI Board concluded by pledging that it “will work diligently to recommend diverse and sustainable funding mechanisms to the Government, ensuring the longevity and success of the NHI Authority for future generations of Bahamians”.

Translated, the notice appears to warning Bahamians - and especially NHI beneficiaries - that there is little choice but to cap and restrict some of the care benefits they enjoy because the healthcare scheme’s costs are exceeding the multi-million Budget financing received from the Government.

By ANNELIA NIXON

anixon@tribunemedia.net