Public Doctors’ Nhi Rejection ‘Very Significant’


Tribune Business Editor


Senior public sector doctors have sent “a very significant” message to the Government by refusing to support its National Health Insurance (NHI) scheme, a well-known physician said yesterday.

Dr Duane Sands told Tribune Business that NHI’s evolution, especially the manner in which it has progressed, was a particular “affront” to the doctors and allied professionals caring for the majority of Bahamians in the public health sector.

The recently-confirmed FNM candidate for Elizabeth in the upcoming general election was speaking after the Consultant Physician Staff Association (CPSA), which represents around 100 of the Public Hospitals Authority’s (PHA) most senior doctors, publicly stated they will not register as primary care providers under NHI.

Dr Locksley Munroe, its president and a general surgeon for 34 years, said this would remain the position until the Christie administration engaged in meaningful consultation with the CPSA, and incorporated its views into NHI’s design.

“I think it’s a very significant statement, and I believe it is yet another request for dialogue,” Dr Sands said yesterday of the CPSA’s position.

“I believe the president said it very clearly that he does not believe - and I believe he speaks for the majority of his members - that the Government has had adequate, respectful, mutually engaging dialogue with the stakeholder group that plays the most significant leadership role in the delivery of healthcare in the country.

“The majority of members in that group, which is not singular in its views, feel the NHI product ultimately rolled out can be significantly better if the views and concerns of this organisation are not only considered - but incorporated - into this scheme.”

The CPSA’s public comments represented a further unwanted headache for the Christie administration, which will also be dismayed at the timing - which coincides with yesterday’s start of NHI registration and the ‘ramping up’ of efforts to implement the scheme.

The Association’s statement effectively amounts to the PHA’s most senior doctors ‘breaking ranks’ with the Christie administration, their employer, over NHI by criticising the way it has handled preparations for the scheme’s roll-out.

It is unclear whether the Government’s NHI plans will be undermined by its most senior medical employees refusing to register as service providers under the scheme.

However, Bahamian doctors and physicians are certainly the profession that has most leverage with the Government over NHI.

Their refusal to register as providers would make it impossible for the scheme to succeed, given the enlarged patient population that the Government wants them to take on.

Dr Munroe’s comments suggest that the Government has sidelined, and ignored, the expertise of its most senior physicians over NHI’s design and roll-out.

And, most damning of all, Dr Munroe said NHI would not resolve - or even address - the most fundamental weaknesses in the public healthcare system.

These, he suggested, were aged and poorly maintained equipment, inadequate physical infrastructure at hospitals and clinics, and shortages of prescription medicines.

And Dr Munroe implied that NHI would merely further overload an already-strained public healthcare system, given that 350,000 Bahamians and legal residents would now have their care financed by the Government.

Dr Sands, meanwhile, said the Medical Association of the Bahamas (MAB) was due to hold its own press conference on NHI later this week.

Tribune Business understands that the planned meeting between the NHI Secretariat and implementation team, and private doctors, had been postponed from the weekend with no new date scheduled.

Some CPSA doctors are also members of the MAB, which also includes private doctors and junior physicians among those it represents.

Dr Sands estimated that there were around licensed 900 doctors in the Bahamas, represented by a variety of associations, and spread across both the private and public sectors.

“It is a particular group of very senior physicians who, for the most part, lead the delivery of healthcare for the majority of the population in the Bahamas,” Dr Sands added, suggesting the importance of the CPSA’s stance should not be underestimated.

“Their statement is a fairly simple statement. If we want to build this country, and healthcare is fairly important, let us all participate in that process in a meaningful way.

“It is an affront to them, when this process has progressed to the point it has, and you have so many professionals who feel their concerns are simply not entertained,” he continued.

“Do not dictate your view of healthcare to people that have been in the trenches, and ignore the views they have, or trivialise or marginalise them when they say the system has problems. That’s just inappropriate.”

Dr Sands said most doctors and nurses working in the public health sector did so out of a sense of “national service”, when there was “no financial advantage” for them to do so.

And he appeared to agree with the CPSA and Dr Munroe that NHI will not solve the public healthcare sector’s problems - at least not by itself.

While praising the quality and expertise of public sector doctors, he told Tribune Business that they were undermined by a system that was “under-equipped, under-staffed and under-capitalised, and has perennial shortages of medicine”.

Suggesting that the public healthcare sector was also handicapped by labour mismatches, Dr Sands said the Bahamas needed to go much further than the investment in Princess Margaret Hospital’s (PMH) Critical Care Block facility.

Apart from “a brand new emergency room at PMH”, he added that the Rand Memorial Hospital in Freeport needed new wards, and a new morgue and blood bank were also required.


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