By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A Cabinet minister is hoping doctors and other National Health Insurance (NHI) providers receive outstanding payments "before the end of the week" as the scheme plans to discuss "additional efficiencies".

Dr Michael Darville, minister of health and wellness, told Tribune Business yesterday that he is "on top of it" after it emerged that the NHI Authority, which oversees the state-sponsored healthcare initiative that cares for more than 160,000 Bahamians, has again exhausted its Budget allocation and is unable to pay sums owed to physicians and other service providers.

Conceding that he "cannot wait" until the new fiscal year begins on July 1, the minister said he and NHI officials held "very favourable" discussions with Ministry of Finance and Public Treasury representatives yesterday morning, during which they were informed the situation will be "resolved very shortly" through the release of the necessary funding.

One doctor, speaking on condition of anonymity, confirmed to Tribune Business that they have yet receive payment from NHI for services provided in both May and June 2025. Describing this as "the new normal" for providers, they added that it has been "delay after delay" when it comes to receiving payment, concluding with the expression: "Jokers."

This has meant that doctors and other NHI providers are financially carrying, and effectively underwriting, the scheme at their own expense, which is likely causing cash flow, liquidity and other financial strains for their own companies.

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.

And she effectively warned providers, and the 160,000 Bahamians cared for under NHI, to brace for potential cut-backs in services and benefits, stating that "additional programme initiatives and efficiencies will be communicated" and discussed before the Government's new fiscal year starts on July 1.

Mrs Butler conceded that NHI had done likewise at this same point in 2024, meaning that similar measures to what was imposed 12 months ago will likely soon be forthcoming. Those implemented last year included  “caps and limits” on a portion of the care benefits received by patients as part of further “cost containment measures”.

Restrictions to laboratory benefits were to be introduced in October 2024 to help to “better manage.... escalating costs”, while limitations were imposed on the size of NHI’s care network. No new  doctors, laboratories and other medical facilities offering services to patients enrolled in the scheme were to be added on New Providence before this fiscal year ends on June 30.

No details were given on what the NHI Authority is proposing this year, although Mrs Butler said the proposed steps were necessary to ensure NHI's "sustainability". This is despite the scheme being allocated an extra $2m for the upcoming 2025-2026 financial year.

Dr Darville, meanwhile, acknowledged that all NHI providers owed outstanding sums needed to be paid after being "alerted" to the situation by the Authority. While unable to give a date, or "guarantee" when payment will be made, he voiced optimism that this will happen "before the end of this week".

This is not the first time that NHI has run short of funding towards the end of the Government's fiscal year, and Dr Darville told Tribune Business: "I had an opportunity to meet with the Ministry of Finance, and we are in the process of solving this problem. I don't think it can wait until the new Budget.

"I believe we are having some traction to resolving this matter, as we have physicians with outstanding payments. I had a meeting at about 11am today in collaboration with the Ministry of Finance and the Public Treasury, and was told the problem should be resolved very shortly. I'm hoping it will be resolved before the end of this week.

"I spoke to the NHI Authority. They alerted me to the situation, and they and myself had discussions with Finance... The discussions were favourable, and they acknowledged the fact it needs to be resolved in the short-term because you cannot have people out for a long period of time," the minister added.

"I'm on top of it; on top of it to get it resolved and get the doctors paid. They've already worked, and anyone who has worked should get their money. I'm not waiting for the new Budget to get it resolved. I cannot wait to get it sorted out."

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. "We got $2m," Dr Darville confirmed of the extra financing for 2025-2026. "In this line of business you never get all you ask for. We are appreciative of that $2m.

"We are trying to be frugal with our means, trying to find ways to have savings on administrative costs. You cannot do much with fees for services provided; that's a contractual arrangement. Any time we see unforeseen challenges and shortcomings we make it clear to the Ministry of Finance, which has been supportive.

"We want to bring more enrollment to NHI, and when you have more enrollment you have more costs. We try to stay within the realms of Budgetary allocations, but if we go over that there are checks and balances in place to resolve that through the Ministry of Finance," the minister of health and wellness said.

"We do have wiggle room to help us, but ultimately we have to fully structure the programme for us to become sustainable. Right now, we're completely underwritten by the Government. We are standing in that space, and trying to pay people on a timely basis."

Dr Darville said NHI has no challenge with paying its bills once it receives the necessary taxpayer "subventions" from the Government, and added: "Right now, it's a very tricky time because we're right in the mouth of the new Budget and are filling some gaps, but we have met with Finance and the response has been favourable to getting the doctors paid."

He also confirmed that there has been "an overlap from the latter part of May to June" in terms of what is owed to doctors and other NHI providers, who have been contacting the Authority to inquire when they will be paid. "We are all on one accord that the Authority needs to have the money in their account in order for it to be disbursed," Dr Darville said.

"Everyone is fully aware of the financial situation, and Finance will move quickly with the Treasury in order to address the shortfall." Mrs Butler, in her letter, sought to place the "delayed provider payments" in the context of the challenges caused by NHI's growth and its unchanged financing that has failed to keep pace with this.

"Over the last few years, the NHI Authority programme has continued to expand with increased beneficiary enrollment, exponential growth in utilisation, particularly for laboratory services, and increased technology fees to accommodate an evolving programme with a demand for NHI Authority facilities and providers throughout the archipelago," she wrote.

"Despite the programme’s growth and obvious success, funding has remained static. Additionally, NHI has experienced challenges related to regularised financing, which have made meeting our obligations to providers and vendors increasingly difficult.

"Although there have been previous payment delays, I recognise that this current delay has extended beyond our collective expectations and has put your organisation and operations in uncomfortable positions."

Mrs Butler pledged that the Authority "is working tirelessly" to resolve the payments situation, but warned that potential restrictions and cost curbs - described as "efficiencies" - are likely to be unveiled and discussed in the coming days. She also urged providers to help it advocate for "proper funding" and timelier payments.

"We have, and will continue, to escalate our requests for adequate and timely funding to meet our obligations and, once received, we will begin processing payments to providers without delay," she said. "Many of you have inquired about the programme's future and sustainability. This is an important and relevant question as you plan to participate in the NHI programme.

"As was communicated last year, the NHI Authority Board of Directors approved several programme efficiencies designed to manage resources and improve programme efficiency and value. Additional programme initiatives and efficiencies will be communicated before the new fiscal year begins on July 1, 2025, and further discussed at the upcoming medical director’s meeting.

"These measures are necessary to address the sustainability of the programme."