Consultants Physician Staff Association (CPSA) President Dr. Locksley Munroe accused the government of "ignoring and marginalizing" the views of local doctors on National Health Insurance (NHI) and warned yesterday that association doctors will not sign onto the scheme unless their concerns are addressed.
The association took that position during an NHI meeting at Breezes Resort yesterday afternoon.
"[The government] needs to pay attention to what your experienced people are saying, otherwise you are not going to get the support you need," Munroe said. "The government is following its usual position where they are calling foreign people and going along with what these persons are saying and not consulting the people on the ground. They are ignoring and marginalizing the physician body here in The Bahamas, particularly the senior physicians."
The CPSA is compromised of just over 90 senior physicians who provide consultancy services for the Public Hospitals Authority (PHA). Munroe said most of the physicians who are members of the association are also a part of the Medical Association of The Bahamas, which speaks for the majority of the doctors in the country. The CPSA's concerns include the model of care for the delivery of primary care, the need for health system strengthening prior to NHI implementation and general confusion surrounding the NHI implementation, among other concerns.
"One of the main problems we have as physicians is there [are] no confirmed positions on many aspects of what the government is proposing," Munroe said. "There was no physician in the association who did not fully support the need for universal health care. But the way in which it is being done is what has physicians recalcitrant and reluctant."
Munroe voiced the association's concerns on the eve of the launch of NHI registration. He noted that several key details have yet to be revealed, such as compensation for doctors, how many primary care providers will be available under the scheme and how beneficiaries will be able to receive service.
Earlier this month, Deputy Chief Medical Officer Dr. Delon Brennen also told The Nassau Guardian that upgrades to the healthcare plant on several Family Islands had yet to be completed. The Guardian understands that upgrades are still incomplete. Without the requisite upgrades and added personnel, Munroe said, the healthcare system cannot sustain NHI.
"If there is an increase in the number of people accessing your system but you don't have in place what is going to be necessary to provide them with this so-called quality healthcare that you are talking about, there are going to be problems," he said.
At Princess Margaret Hospital (PMH), we don't have an MRI; we don't have sufficient nursing staff.
"A whole lot of things are not there. We need NHI, but you need to bring it in, in a manner that works. Otherwise you will create a greater problem. They are bringing in a model of this healthcare that totally won't work in The Bahamas.
"A lot of clinics won't meet the criteria. It's a matter of how you take something," Munroe said. "You just cut and paste something from overseas and say this is what we are going to do."
Munroe said the government also has yet to show how NHI will impact the quality of healthcare, or the cost of healthcare.
"Those are some of the concerns," he added. "We are going to put that position through to the MAB, except we are going to add one thing: If the government is not hearing what we are saying, we are not going to sign onto implementation, the senior physicians. Unless we have a tangible and real input into what will take place, we will not be a part of it. And if you take out all senior physicians then what quality of care are you delivering?"
In its position paper on NHI, the Medical Association of The Bahamas said before The Bahamas can move toward universal health care (UHC) the existing public heath system must be "rescued and brought up to internationally acceptable medical standards". MAB released its position paper late last year.
"The provision of health care for all currently exists in The Bahamas," the paper states. "Over the last two decades, population increases, financial mismanagement, a lack of an implemented national strategic plan and the isolation of the public system from any medical regulatory processes [have] eroded and in reality [have] diminished the public sector health care system.
"Our first priority in the development of UHC is to rescue, renovate and rejuvenate the public health care system. In many cases, the disparity in public and private care are based on circumstances beyond the control of medical professionals. In some cases, it is based on years of a progressively worsening system affecting the overall morale of the medical profession."
NHI is expected to be introduced in phases.
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