By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A Cabinet minister yesterday said “new revenue” is not required to finance an expansion of free medicine for Bahamians with chronic non-communicable diseases, as he asserted: “This ain’t no pie in the sky.”

Dr Michael Darville, minister of health and wellness, told Tribune Business that long-standing ambitions to expand the National Chronic Drug Prescription Plan’s reach will be funded from “massive savings in tertiary care costs” generated by keeping Bahamians suffering from diabetes, hypertension and other similar diseases out of Princess Margaret Hospital (PMH).

Rejecting assertions by the Opposition and others that this is merely an “election campaign” ploy, he argued that combating chronic non-communicable diseases - which have grown to “epidemic proportions” - at the earliest stages of primary care via the provision of free medications will generate savings “on the back end”.

Dr Darville also told this newspaper that the 160,000 patients he referred to in the House of Assembly last week represents the number of Bahamians enrolled in the National Health Insurance (NHI) scheme, to which the National Chronic Drug Prescription Plan will ultimately be transferred to. The 160,000 figure is not the number of persons with chronic non-communicable diseases, which he said is far fewer.

This means that the scale and scope of any ‘free medication’ expansion will be less than previously allowed for. Dr Darville, explaining that the National Chronic Drug Prescription Plan has been switched to his ministry’s management until changes are made to the NHI Act and other essential legislation, yesterday pledged that the necessary legal reforms will be tabled and debated in Parliament before this May’s Budget.

“There’s always going to be naysayers with any plan you out in place,” the minister said, responding to Dr Duane Sands, an ex-minister of health, and others. “We’ve been working on this for almost a year. The [National Chronic Drug Prescription Plan] is nested in my ministry. “

Of the 44,000 persons currently enlisted with the Drug Plan, “the majority of them” have chronic non-communicable diseases. Dr Darville said it had always been the Government’s objective, dating back to the 2013-2014 report on healthcare reform by Sanigest, to provide free medicines to persons suffering with hypertension, diabetes, heart disease, certain types of cancers, renal insufficiency, mental illness and other illnesses.

“Our intent from the Sanigest report was always to provide free medicines to people with chronic non-communicable diseases,” he added. “When the former FNM administration implemented the Drug Plan with the National Insurance Board (NIB), subsequently the entire programme was financed by the Ministry of Finance. It was completely underwritten by the Government for years.

“That particular financing component came to my [ministry’s] Budget this year. The key was NIB did not have the technical support like physicians and others to organise it.” Determining that the Drug Plan should ultimately come under and be part of NHI, Dr Darville said its transfer to the Ministry of Health and Wellness effectively represents a transition year until the required legislative changes are passed by Parliament.

Explaining the rationale for the ‘free medicines’ expansion, and how this will be financed, Dr Darville told Tribune Business: “We did some studies on our beds. We realised that a lot of the people consuming the beds at the hospital had organ damage brought on by non-communicable diseases.”

And, with no way to monitor or track whether patients possess the necessary drugs, are complying with doctors’ orders and recommended dosages, or have made the required dietary and lifestyle changes, he added that the Government and its consultants determined that better access to medication could help treatment, reduce the burden on PMH and lower healthcare costs associated with tertiary/hospital level care.

“As we began to make the assessment, the Government realised that, because we are not offering the drugs, we are spending a large amount of money for people on the wards,” Dr Darville explained. “There’s a real savings if we treat people earlier and make sure they have access to the drugs.

“There’s a lot we can save on tertiary care costs if we are able to provide medications for people with chronic non-communicable diseases. We can have better outcomes and massive savings with care costs at tertiary care.” Dr Darville said the strategy involves “pumping up primary care”, and improving public education and wellness, to try and reduce the number of such patients requiring care at PMH.

“We have revenue on the back end,” he explained of his and the Government’s strategy for financing this. “It’s not a matter of finding new revenue. It’s cost savings from lowering the number of admissions. I foreshadowed it so we can start the discussion.

“A lot of people think it’s pie in the sky, Darville’s doing this. It’s simple. And many countries are doing this. We are focusing on chronic non-communicable diseases which are at epidemic proportions in this country.” To aid treatment of such illnesses, the minister said a “digital platform” linking primary and hospital care is needed to track and follow-up with patients to ensure they have the required medicine.

Noting that drug access, dietary and lifestyle change and treatment are all inter-connected, Dr Darville said: “It’s a plan I’ve been working on with my consultants. I didn’t wake-up one night and think about it. We’ve been working on it for years. NHI is where it belongs.

“This is where we are heading. We are in the final stages of the Bill. We have one or two more consultations. I intend to debate it in Parliament before the next Budget. This ain’t no pie in the sky, this ain’t no election campaign. This is about keeping people out of hospital and those cost savings will be more than what the cost of medication is.”

Dr Sands had previously challenged how much it will cost - and where the Government will find the money to pay - for the expansion in free medications to all patients with chronic non-communicable diseases.

Speaking as other physicians, talking on condition of anonymity, confirmed that “the Government right now owes us for last month’s National Health Insurance (NHI) services; we haven’t been paid yet”, he suggested that the minister of health and wellness’ House of Assembly presentation was made to “put a chicken in every pot” with a general election now at most 18 months away.

“It is clear that we’re in election season,” Dr Sands told this newspaper. “The minster of health has this proclivity of making promises that he may not be able to keep. I am advised that the Public Hospital Authority’s accounts with large suppliers of pharmaceuticals have been cut-off for non-payment.

“And, if true or not, there is a serious shortage of medications in the public health facilities. How is it you can’t keep medications in stock now but you’re going to increase their availability to 160,000 people? How is it you can claim to be expanding the benefits for NHI when you cannot pay the bills now, and providers cannot be paid on time?

“We owe vendors for dialysis, we owe vendors for garbage collection. It is surreal for the minister to make these promises when the PHA and Ministry of Health are in such a serious cash crunch as it is, and the Government is in such a serious cash crunch when we see them at this massive $395m deficit in six months. That does not even include bills incurred that have not yet been paid.”