By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

National Health Insurance (NHI) funding must be “expanded” to match the scheme’s benefits growth, the Medical Association of The Bahamas (MAB) president says, describing this as “open for discussion”.

Dr Nikechia Hall-Dennis, in a recent interview with Tribune Business, said the Association is continuing to call for both its members and all doctors providing services to the Government-run and managed healthcare scheme to be paid in full and on time. She acknowledged that the late payments by the NHI Authority are creating financial challenges for physicians.

“We are aware of it and have spoken to them about it,” Dr Hall-Dennis added of the payments. “They [the NHI Authority] are making their best efforts to resolve the problem. It’s difficult because if most of your practice is seeing primarily NHI patients, then your income is coming from those patients.

“So the ability to pay your staff, your ability to pay the bills of your office, and provide the basics that NHI requires of the physicians, it’s difficult to meet them if you are not getting those payments. That creates a difficulty where physicians want to provide the best level of care but it is increasingly difficult for them to do so.

“As the payments are capitated, the volume of patients that you have doesn’t necessarily go along with the capitation of payments. There is a very fixed amount that you get from your patient population if they are predominantly NHI patients. You can continue to see patients regularly without getting any more funds, so if you’re not getting paid it’s difficult.”

Doctors who provide services to NHI, speaking on condition of anonymity, said they received another payment for June in late July, meaning that the scheme is around a month behind in paying them for services rendered.

One said that doctors serving NHI are paid $12.50 per patient per month - a fixed-rate capitation payment that has not altered in eight years. “That hasn’t changed since 2017, but the cost of living has gone up by 30 percent in that time and they are not paying us any more,” they said.

“I’m a self-employed person and I have people to pay and the utilities and other things businesses have to pay. It’s a complete shambles as far as I’m concerned. They paid us 30 percent of June on July 3, then they paid us 35 percent. There should be another 35 percent to come.”

Another doctor confirmed: “They’re a month behind. This is nothing new. This has been going on for six months at least. How the average physician copes with it frankly I don’t know. There are physicians where 90 percent of their practice is NHI patients.

“If they cannot pay for what they are offering now, how can they pay for anything more? We have staff to pay, we have bills to pay, we have significant overhead costs and it’s not taken into consideration by their payments and we have no communication other than to say we’re not paying you by the way.

“That’s their [the Government’s] unfortunate operational procedure. Unfortunately, that’s the way the Government operates. I think there’s this apathy created among the general populace that the Government pays its bills when it wants to pay, but you and I, the taxpayer, when we miss VAT returns and Business Licence, they charge us a penalty? Why is the Government being charged for not paying? What’s good for the public is good for everyone.”

Dr Hall-Dennis, meanwhile, said the Association is in constant contact with the NHI Authority to advocate for “fair treatment” for its members and healthcare professionals who provide services to NHI when it comes to the need for in-full and timely payments.

And, speaking before last week’s House of Assembly debate on the NHI Bill, which paves the way for the Government to levy contributions from Bahamian employers and the self-employed to finance the scheme, she added that wide-ranging discussions need to be held on “marrying together” the expansion of healthcare benefits and care with the requirement for increased funding.

Warning that the two cannot be divorced, Dr Hall-Dennis told this newspaper: “That’s really open for discussion how we are, going forward, to provide funds to adequately finance and sustain NHI. Healthcare, in and of itself, is an expensive thing and there’s a limited amount of funds that can be necessarily be provided by the Government.

“There may have to be some debate on the way funds are generated for healthcare, and that is really going to have to be addressed at some point. Costs do tend to go up, and the more NHI provides for beneficiaries, the more costs will increase.”

Dr Hall-Dennis said expanding NHI’s coverage and treatments “is a good thing” for Bahamians, as it will increasingly give them access to more affordable healthcare, “but the more things that are provided, the more costs are increased”.

She added: “I think that if the scheme wants to be expanded then the funds have to be expanded. This has to be anticipated and that due process put into how these two things will be married together.”

Dr Michael Darville, minister of health and wellness, last week confirmed The Bahamas will “eventually have to pull the trigger” on employer and employee funding for NHI but it is “premature” to do so now.

He confirmed that the NHI Bill debated in the House of Assembly on Wednesday does “make way” for the healthcare scheme to adopt a model where it is financed by contributions from Bahamian employers, the self-employed and workers but such a move is “not on the table” at present.

Affirming that NHI will remain a government-funded scheme underwritten by Bahamian taxpayers for the foreseeable future, he added that multiple “preparatory steps” have to be implemented and completed before a scheme funded by business/employee contributions can even be considered.

These initiatives include upgrades to the existing public healthcare network’s infrastructure, the installation of new information technology (IT) systems and the time required for Bahamian private health insurers to adjust the pricing and content of existing medical policies and benefits packages to make way for the standard health benefit (SHB) introduced by the NHI Bill.

The NHI Bill’s section 15 provides for the NHI Authority, the body that governs the plan, to use “monies payable by an employer of an insured person, or monies or allowances payable by a self-employed person for standard health benefits or other health benefits under this Act”.

Taxation, or some form of levy, imposed on employers and working Bahamians to finance NHI is far from a new idea. Who pays, and how much, have always been key issues ever since the scheme was first conceived by the initial Christie administration in the early 2000s. However, both employers and the self-employed are unlikely to welcome any new and/or increased taxes - especially at this time.

Tribune Business reported at end-June that that the NHI Authority, which oversees the state-sponsored healthcare initiative that cares for more than 160,000 Bahamians, had again exhausted its annua; Budget allocation and was unable to pay sums owed to physicians and other service providers.

Christy Butler, the NHI Authority’s managing director and chief executive, in a conciliatory letter acknowledging the impact the scheme’s financial challenges are having on its service providers, attributed the woes to the inability of its “static” $46.2m annual Budget allocation from the Government to keep up with ever-growing patient numbers, its expansion and rising costs.

The Davis administration expanded the NHI Authority’s annual funding by $2m in the Budget, increasing it from $46.2m to $48.2m for the 2025-2026 fiscal year - an amount projected to remain the same for the following two fiscal years. For 2024-2025, NHI had used up $36.135m - some 78.2 percent of its full-year $46.2m allocation - by end-March, which marked the fiscal year’s three-quarter mark.

This suggested the remaining $10m was likely to be inadequate to see the NHI Authority through to the June 30 year-end.