By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The National Health Insurance (NHI) Authority will today eliminate restrictions on Bahamians enrolling in the scheme in a move branded as “damn the torpedos” by an ex-health minister.

Dr Duane Sands, the Opposition’s chairman, speaking out as the Authority removes the extra 90-day wait persons must endure before they can join NHI, challenged how the Government-funded healthcare scheme will be able to “pay for” the increased patients - and associated higher costs - when it was unable to stay within its $46.2m budget for the 2024-2025 fiscal year.

Describing the NHI Authority’s announcement of the changes as “a fascinating missive”, he argued that ending this curb - as well as eliminating the current cap on the number of doctors and other medical professionals providing services to the scheme on New Providence - “makes absolutely no sense financially”.

And Dr Sands, who was minister of health under the Minnis administration, told this newspaper that it appeared the Government has decided “blowing a hole in the Public Treasury” is its route to securing general election success given NHI’s need for extra taxpayer funding to pay its bills prior to yesterday’s 2024-2025 fiscal year-end close.

However, Dr Michael Darville, minister of health and wellness, told Tribune Business that “for the first time since its inception NHI is bringing the public [sector] clinics on” as a way for the Government to retain some of its expenditure. The revenues the clinics will earn from providing laboratory and diagnostic services to NHI patients, he explained, will now be retained by the Government.

And, as a result, the minister asserted that these monies will be reinvested in further upgrading the Department of Public Health’s clinics as well as financing the enrollment of more Bahamians to NHI and the scheme’s expansion. This, Dr Darville explained, will ensure NHI has sufficient funding as he confirmed that late payments due to doctors and other NHI providers were being made from last week.

The NHI Authority’s move to eliminate previous barriers to both patient and provider access were detailed in a letter dated Friday, June 27, which unveiled changes due to take effect today. For Bahamians, the biggest development is the elimination of the extra 90-day wait before they become enrolled as NHI beneficiaries, which was imposed some 20 months ago in November 2023.

While this will likely benefit healthcare, and Bahamians’ access to it, the NHI Authority’s letter also repeatedly acknowledged the “resource constraints” that the scheme has faced over the past 12 months as well as challenges in attaining “financial sustainability”.

“Despite the programme’s unprecedented growth and potential for further health care transformation, resource constraints were experienced in the 2024-2025 fiscal year,” its directors wrote. “As NHI Authority seeks to ensure the adequate distribution of resources and secure the programme’s financial sustainability, the Board of Directors has approved the following initiatives for fiscal 2025-2026.

Describing the “removal of the 90-day enrollment period”, the NHI Authority said: “Effective July 1, 2025, NHI Authority will revert to the previous standard processing timelines, allowing beneficiaries to access services in a shorter period post-enrollment. Accommodations will be made for beneficiaries with a current pending enrollment date.”

The 90-day wait was unveiled 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.

The extra 90-day enrollment period was added to the existing “standard” time for Bahamians to be on-boarded to NHI. This has meant, for example, that someone who enrolled with NHI on or after November 22, 2023, had to wait until April 2024 to fully join. Existing NHI beneficiaries were not impacted.

Meanwhile, the NHI Authority’s letter also revealed that, as of today, the limitations imposed last summer 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, are being removed.

Described as the “resumption of provider onboarding”, the NHI Authority said: “The provider network expansion throughout the archipelago will continue to be guided by resource and capacity management considerations. Based on current capacity needs, there will be opportunities for onboarding facilities and providers in fiscal 2025-2026 in New Providence and the Family Islands.”

Dr Sands, though, said the letter’s repeated references to “resource constraints”, and warning that “additional measures” will be taken if necessary to ensure NHI’s sustainability, suggested it is “very clear” that the directors themselves are “quite sceptical about the resources available for this mandate”.

“I don’t know how to interpret that other than to say there appears to be a disconnect between the Board and the political directorate,” he told Tribune Business. “That’s damn the torpedos. We’re going to enroll as many people as possible and provide all the benefits, even though we’re not sure how to pay for it.”

One doctor, speaking on condition of anonymity, agreed with Dr Sands, adding: “More providers and members means more monies to be paid out.”

Tribune Business revealed last week how the NHI Authority had to request extra funding from the Ministry of Finance to cover unpaid bills owed to doctors and other NHI providers after the scheme exhausted its budget for the 2024-2025 fiscal year.

One doctor, speaking on condition of anonymity, said they have now received payment for May 2025 while 50 percent of the sums due for laboratory services for that month have also been disbursed. But Dr Sands added: “If you couldn’t make it work before with the budget you had, and now you’re just going to open everything up, it makes absolutely no sense financially.

“Again, I’m not surprised, not in the slightest bit surprised. They’ve [the Government] got an election to try and win, and figured that blowing a hole in the Public Treasury was the way to do it or creating more ‘red ink’ at the Public Treasury was the way to do it because they have not paid their bills this year.

“Once again it’s voodoo economics and makes absolutely no sense. While it’s important to focus attention on healthcare, this could be financed if a lot of wasteful expenditure was eliminated. Maybe if they cut back on consultancy fees by $50m they could cover the Public Hospitals Authority, NHI and their shortfalls. No. We’re going to continue to spend even more despite the limited addition to the budget. It’s crazy.”

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.

And the Ministry of Health and Wellness has seen its recurrent (fixed-cost) spending budget increased by $22.37m for the upcoming 2025-2026 fiscal year, taking this from $332.747m in 2024-2025 to $355.12m, while the Public Hospitals Authority (PHA)’s taxpayer subsidy has expanded by $15.4m - growing from $232.456m in 2024-2025 to $247.856m. This is designed to address such “shortfalls”.

The NHI Authority, meanwhile, said payments to doctors will start after a patient’s first visit to their primary care provider. “As of July 1, 2025, capitation payments will start after the beneficiaries’ first visit to their assigned primary care provider. This will only apply to newly-enrolled and reassigned beneficiaries,” it added.

“Effective July 1, 2025, NHI Authority will introduce credentialing and digitisation fees for newly-onboarded facilities and will implement the same for existing providers in the next calendar year. These fees will support the provider credentialing process and increase the programme’s digital footprint for future evidence-based decision-making.” A fee schedule is to be released.

Acknowledging past challenges, the NHI Authority added: “Awareness campaigns will be launched as needed and where applicable to inform beneficiaries, providers, and the public about these new measures....

“The NHI programme continues to grow and expand throughout the archipelago of The Bahamas, aiming to transform primary care delivery on the journey to achieving universal health coverage. During the upcoming fiscal year, NHI will continue to progress crucial programme initiatives such as legislative reform, National Prescription Drug Plan integration, healthcare digitisation and the advancement of population health reporting.”

The NHI Authority continued: “The programme’s sustainability is paramount, and the above decisions have been carefully and thoughtfully considered with that mandate in mind. The NHI Authority Board of Directors and executives are committed to responsible governance and resource allocation.

“Our provider network and the Bahamian public deserve a programme that evolves to address current needs and realities. 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.

“We thank all providers for their patience and partnership, particularly during the 2024-2025 fiscal year. NHI Authority recognises and appreciates the impact that resource constraints have placed on our providers and will continue to advocate for NHI Authority’s sustainable funding,” the letter added.

“NHI Authority will communicate openly and transparently with providers throughout the upcoming fiscal year regarding programme challenges, realities and partnership opportunities. The NHI Authority Board of Directors and executives are working diligently to ensure the longevity and success of the NHI Authority for future generations of Bahamians.”