Patients between 18 and 64 who are admitted to the public wards at Princess Margaret Hospital (PMH) are more than fives times as likely to die than those on the private wards, according to a report completed by Costa Rican consultants Sanigest Internacional. For patients over 65, the likelihood of death in PMH is more than double on the public wards than on the private wards.
The 500-page report obtained by The Nassau Guardian outlines various scenarios for National Health Insurance (NHI). It also provides a comprehensive review of the health care sector in The Bahamas.
For 2012, the mortality rate for patients ages 18 to 64 stands at 2.7 percent on the public wards of PMH compared to 0.5 percent on the private wards, the report says. The mortality rate for patients over 65 stands at 14.8 percent on the public wards compared to 6.9 percent on the private wards, according to the report. It notes the reasons for the "wide variations, which highlight possible inequities" between the two sectors, include greater severity in illness at admission for public patients and a high rate of emergency admissions to public wards.
"However, given that the data is adjusted for age, it is not likely that the differences in severity are that extreme to explain a doubling of mortality rates," the report says.
The report states that it does not include patients in the Neonatal Intensive Care Unit (NICU) or Intensive Care Unit (ICU), which would increase the mortality rate in the public wards. PMH has an average mortality rate of 4.6 percent, the report says. This is more than three times the U.S. average mortality rate of 1.3 percent. The estimates are based on data from the Public Hospitals Authority. The report cites the 2013 Household Expenditure Survey, which indicates that access to private medical insurance in The Bahamas is "very unequally distributed".
"Data from the 2013 Household Expenditure Survey shows that the poorer the household the less likely individuals are to have private health insurance," the report says. "And in general, people in lower income brackets without private health insurance will be unable to afford care in the private wards. As such, there is a clear issue with equity in access to care, which is providing higher outcomes."
The report adds, "Over time NHI will help in addressing this issue and create additional equity by increasing access to health services for some people of the lower quintile groups in the population; promoting a primary care model approach which should result in less hospitalization and incentivizing the public sector to improve the quality of their services."
During the mid-year budget debate last week, Health Minister Dr. Perry Gomez said, "If you are black and you are poor, you die."
Prime Minister Perry Christie originally made that statement when speaking about the need for NHI in The Bahamas.
The estimated cost of NHI is $362 million annually for the most basic package and $633 million for an expanded benefits scenario.
The NHI system will be compulsory and all legal residents will be required to participate, the report says. Although undocumented migrants will not be explicitly covered under NHI they will continue to receive access to certain services. The consultants also provided options for how NHI could be funded. They range from a payroll tax up to 5 percent to additional taxes on auto insurance, alcohol and tobacco, and a higher departure tax.
The consultants also propose a surcharge on water, electricity and cable TV. The consultants say another option for funding NHI is earmarking portions of value-added tax and web shop taxes to the scheme. Last week, Gomez said no decisions have yet been made regarding financing the plan. The government says it intends to implement NHI in January 2016, but a reading of the Sanigest report indicates that the Christie administration is way off in meeting certain targets necessary to make the introduction of NHI on that date doable.
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