By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

National Health Insurance (NHI) will “fail completely” if it expands patient numbers and benefits without “immediately fixing” current payment backlogs, the Opposition’s finance chief argued yesterday.

Kwasi Thompson, the east Grand Bahama MP, told Tribune Business that the Government-funded and managed healthcare scheme will find itself in an “unsustainable position” if it fails to provide extra financial, staffing and other resources to cope with the expected increase in demand given that it is already struggling to pay its bills.

Noting the constant complaints from doctors, and other healthcare providers, that NHI has not been paying them in full or on time for months, he voiced concern that “chaos” will erupt if the Government does not rapidly address what he branded as “a structural failure waiting to happen”.

Although the Opposition supported the NHI Bill and other healthcare legislation that was debated in the House of Assembly, Mr Thompson told this newspaper its concerns focus on whether the Government can properly execute and implement the reforms that will be enshrined in law.

And, spotting that the Bill paves the way for the Government to finance NHI through taxation, or some form of levy, on Bahamian employers and self-employed persons, he challenged Dr Michael Darville, minister of health and wellness, to identify “what other sources” of funding may be used and when this will happen.

The minister, in leading-off debate on the five healthcare Bills, made no mention of any move to tap financing sources outside the Public Treasury. However, 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”.

Instead, Dr Darville asserted that NHI is “bursting at the seams” in a different way - the Bahamian public’s support for the scheme, which he placed at 95 percent. He added that “patient satisfaction” with the quality of care and treatment currently stands at 90 percent, and reiterated: “The Bahamian people want NHI.”

The Bill, which introduces the standard health benefit (SHB) as the minimum care and benefits package available to Bahamians, also sets out the NHI Authority’s functions and powers “as the primary funder for private and public care with financial incentives so that money follows the patient”.

“The Bill creates a clear governance structure and funding streams to ensure transparency, fiscal responsibility and long-term sustainability,” Dr Darville said. “This Bill expands the provider network so that Bahamians on the Family Islands can accept, and have access to, this standard basic package; not only those on New Providence and Grand Bahama, but those across the archipelago.

“The Bill also allows for the expansion in prescription drug coverage and select critical care, such as dialysis and cancer care.” Dr Darville, seemingly addressing the payment concerns of doctors and other NHI providers, said the legislative reforms will cut the claims processing time by 50 percent and “reduce paperwork” by 40 percent.

“The Bill unifies enrollment, claims processing, the timely payment of providers, reduces paperwork by an estimated 40 percent and cutting claims turnaround in half.” Some 161,000 Bahamians, or 40 percent of a 400,000-strong population, have already enrolled with NHI. That number includes 17,000 in the Family Islands, and 27,000 on Grand Bahama.

Dr Darville, hinting that these numbers are set to further expand, said the scheme has allowed Bahamians to see a primary care doctor of their choice at no cost and without having to pay a point-of-service fee. He added that the latest reforms seek to address “real life challenges” that result in many Bahamians delaying, or avoiding, vital treatments because they cannot meet the cost.

Mr Thompson, though, warned that a “bureaucratic tsunami that could bury the very people we are trying to help” may result if the Government expands NHI care and treatments, and patient demand surges, without addressing the public healthcare system’s existing staff shortages, lack of resources and other inefficiencies.

Telling Tribune Business that expanding NHI without addressing its existing struggles is “the huge challenge”, Mr Thompson also pointed to the legislation paving the way for the scheme to source additional funding beyond the $48m provided by the Public Treasury in the 2025-2026 Budget.

“That is also one of the aspects of the Bill that speaks to being able to fund it from outside sources,” the east Grand Bahama MP said. “The Government has to be clear when that is supposed to take place. Dr Darville did not make mention of what those other sources are and when those sources will take effect.

“In the Bill itself, it does have provision for where they [the Authority] can receive funds from outside the Fund.. The Bill speaks to additional sources. The minister did not say when that will become active, when that becomes effective. The minister is going to have to speak to that and be clear with the Bahamian people at what time, and what additional sources of funding, will be.”

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.

Mr Thompson, meanwhile, questioned the wisdom of expanding NHI when it is presently struggling to pay its bills. Doctors who treat the scheme’s patients last week told Tribune Business they have received payment for services rendered in June, but have yet to receive what they are due for July.

“A point we have raised is doctors, nurses and healthcare professionals are not being paid on time, so they are already struggling to pay the doctors on time,” he added. “We are concerned that, if they are having difficulty paying provider on time now, and funding NHI now, with the additional benefits and providers we are very concerned .

“They must fix the system immediately to ensure doctors and nurses are paid on time. They are the engine behind NHI and, if we cannot ensure they are paid on time, the entire system will fail. We are advised by a number of doctors that are a part of the NHI system that this is a real problem. They need the funding to be sustainable.

“With the additional benefits, doctors will be more active in the NHI system, and doctors not currently active will become active. Some doctors will become de facto public servants because of their reliance on NHI. It must be fixed, and fixed immediately. It is not a sustainable position. The Government must address that immediately,” Mr Thompson said.

“In terms of the existing system and existing benefits, we must ensure that the doctors are paid on time. They are the engine behind NHI and must be paid on time. If they are not paid on time the entire system is threatened.”

Mr Thompson, in his earlier House of Assembly presentation, also urged the Government to strengthen the overall public healthcare system before expanding NHI. “We cannot ignore the looming threat that lies beneath the promises of this Bill; a bureaucratic tsunami that could bury the very people we are trying to help.

“Let us be honest: Our public health system already struggles under the weight of under-staffing, inefficiency and delay. Patients today, even with private insurance, often face agonising waits for pre-approval - sometimes days, even weeks - for a test or essential treatment.

“Now imagine adding over 100,000 beneficiaries, many seeking new services that may also require pre-authorisation and case management. Without urgent and deliberate preparation, we are inviting chaos. Are we sleepwalking into a bureaucratic nightmare? The Government must not simply hope for the best; it must be ready with expanded staffing, upgraded systems and bold administrative reform.”

And, returning to NHI’s existing payment issues, Mr Thompson added: “What will happen when this system is suddenly expanded to cover new services, new patients and new providers? The answer, madam speaker, is chaos. The Government is already behind; it cannot afford to fall further.

“This issue must be fixed, and it must be fixed now. If the financial pipeline is broken - if our doctors and nurses can’t be paid on time - then no amount of promises in law will deliver real care in the community. This is not just a technical glitch; it is a structural failure waiting to happen, and it must be resolved before implementation proceeds any further.”