By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

National Health Insurance (NHI) needs “a significant increase” in funding to “sustain the quality of care” after patient visits to doctors and other providers increased by 84 percent in just two years.

Dr Duane Sands, a former minister of health, told Tribune Business the 67,228 rise in ‘patient appointments’ between 2022 and 2024 showed the Government-run scheme will not be able to maintain treatment standards and improve the quality of “health outcomes” unless more funding and other resources are provided to keep pace with this growth in usage.

While the patient visits data, disclosed in the recently-released NHI performance report for 2024, is in many respects positive because it shows Bahamians are increasingly accessing primary healthcare services, the Opposition’s chairman reiterated his long-standing concern that the ‘value for money’ received by numerous patients remains “absolutely dismal”.

However, Dr Michael Darville, minister of health and wellness, in a statement responding to this newspaper’s inquiries hailed the 85 percent increase in patient visits as an indication of NHI’s “transformative impact” on the health and quality of life for many Bahamians. He added that the rise showed “growing public trust” in the scheme.

The 2024 performance report, compiled by the NHI Authority, which oversees the Government-funded and managed healthcare initiative, also detailed double-digit increases in patients diagnosed with chronic non-communicable diseases (CNCD) such as cardiovascular disease and diabetes, via 74 percent and 28 percent rises, respectively.

Dr Darville said these increases were “one of the most encouraging shifts” as they suggested Bahamians are “embracing preventative care” through the access provided by NHI, enabling illnesses such as hypertension to be detected much earlier.

And, while acknowledging that “continued investment in NHI is not only necessary but vital”, the minister said the NHI Authority’s performance report showed the scheme “is an accountable and effective means” of delivering healthcare to Bahamians. He added that equal access to affordable healthcare for all is the “cornerstone” of the Government’s plans.

But Dr Sands, noting that CNCD illnesses have reached an “unparalleled level” in The Bahamas, also accused Dr Darville, a successor as minister of health, of a “cop out” by introducing an NHI Bill that paves the way to finance the scheme through employer, self-employed and worker contributions but electing not to execute or “pull the trigger” on this.

He spoke out after the 2024 NHI performance report, which has been seen by Tribune Business, showed that both scheme beneficiaries and use of the primary care services provided continue to expand rapidly despite the only source of funding - taxpayer subsidies - remaining static at $46.2m until this fiscal year’s $2m increase.

NHI beneficiaries were shown to have expanded from 141,092 at year-end 2022 to 159,281 some two years later - an increase of 18,189. Bahamians covered by NHI increased by 9 percent, or 12,038, in 2023 to hit 153,130 at year-end, before their numbers enjoyed a further 4 percent or 6,151 person expansion in 2024.

Usage of NHI’s doctor, laboratory services, meanwhile, grew at an even faster rate than enrollment. ‘Appointment counts’, representing the number of patient visits to doctors and other NHI providers, soared by 85 percent or 67,228 over the two years between year-end 2022 and 2024 - expanding from 78,632 to 145,860. The biggest jump of 44 percent, or 44,841 visits, occurred in 2023.

“From 2022 to 22024, appointment counts increased by 67,228 visits representing an 85 percent rise over the two-year period,” the NHI Authority said. “This strong upward trend indicates that not only more beneficiaries but also a greater frequency of primary care services utilisation over time.”

As to the consequences of increased patient usage having to be financed from an unchanged budget, Dr Sands told Tribune Business: “The expectation would be that there would have to be a proportionate increase [in funding] or even, if not a direct one:one increase, there would certainly be a significant increase to sustain the quality of care people get while paying attention to the sustainability of the programme...

“There are no surprises there [with the report], but we are not going to be able to provide the type of quality care, with diagnostic and therapeutic interventions people need, without having the resources to do it. If we try to do otherwise, we are going to waste our time.”

The ex-minister suggested the Government dedicate just an extra 0.5 percent, or even 0.25 percent, of the $3.887bn in revenues it is projected to earn during the 2025-2026 fiscal year towards increased healthcare financing. This, he added, will enable NHI to keep pace with the ever-growing demand for care following its struggles to pay bills in full and on time in recent years.

Arguing that healthcare funding is being “neglected”, Dr Sands asserted: “As a consequence, look at the percentage of Bahamians who spend the last ten years of their life suffering from illness. The percentage is huge. When you look at years spent either disabled or economically inactive, the percentage of Bahamians who fall into that category is huge.

“The net negative impact to our economy, the net negative impact to our quality of life, is huge. A significant amount of our people stumble from clinic to clinic, emergency room to emergency room, hospital bed to hospital bed.”

Dr Sands also suggested that Dr Darville “took the out” in Parliament last week by introducing legislation that gives NHI options to seek alternative funding sources but not executing on this himself. “It will be very interesting to see as they ramp up NHI,” he added.

“The minister suggested there would be no effort to make funding more sustainable, and that he was only setting up the legislative framework to do so. How does that make sense? That sounds like a cop out.”

Dr Darville, though, focused on the positive aspects of the NHI Authority’s performance report including a 30 percent increase in consultations via tele-medicine. He added that NHI is succeeding in improving the health and quality of life for many Bahamians by providing them with greater access to affordable primary care services.

“The 2024 performance report of the NHI Authority (NHIA) highlights the transformative impact of the National Health Insurance programme on the health and well-being of our citizens. With over 161,000 beneficiaries now enrolled, and an impressive 85 percent increase in appointment visits over the past two years, the data reflects growing public trust and widespread utilisation of the programme,” Dr Darville said.

“One of the most encouraging shifts is how Bahamians are embracing preventative care, getting screened earlier and often, thanks to the accessibility provided by NHI. This has led to significant improvements in early diagnosis and preventative care, particularly for chronic non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, respiratory conditions and obesity.

“For example, diagnoses of Type 2 Diabetes rose by 28 percent, and cardiovascular disease cases increased by 16 percent, indicating enhanced detection and follow-up care. A 42 percent jump in annual wellness visits and 12 percent more lab testing further confirms the programme’s success in encouraging regular health monitoring.”

Looking to the future, Dr Darville added: “The recent passage of new NHI legislation paves the way for further programme expansion. Continued investment in NHI is not only necessary but vital. The data demonstrates that a national health insurance programme is an accountable and effective means of delivering care, measuring health outcomes and managing the health status of our population.

“Importantly, the report underscores the need to ensure that all beneficiaries have access to the essential services they deserve. Equity in healthcare access remains a cornerstone of our mission. We remain committed to building a healthier Bahamas, where every citizen has access to quality, affordable healthcare.

“The NHI programme is a cornerstone of that vision. The results of the 2024 performance report clearly demonstrate that the programme is working as intended, and we must continue to strengthen and expand it in the years to come.”