Consultant Physicians Staff Association (CPSA) President Dr. Locksley Munroe yesterday called for the government to delay the April launch of the primary care services phase of National Health Insurance (NHI) until it can overcome some of the challenges that continue to plague the scheme.

"This thing is not a small thing and it's not anything that you can roll out in one or two [months]," said Munroe, who was contacted for comment.

"There ought to be a delay to make sure the things are going to work. However, registration should continue because you will get a better idea of who it is that you have to deal with. Secondly, public institutional and capacity strengthening efforts should continue. You can't stop the other arms of NHI."

He said the state of Princess Margaret Hospital (PMH) is such that if he did not work there and wasn't a "known face", he would not likely choose to undergo surgery at the facility, given the lack of adequate staff and equipment.

Primary care services is set to begin in April at a cost of $25 million per fiscal quarter, according to the government.

Munroe said while the government is moving in the right direction as it relates to NHI, it must ensure that the system is not overwhelmed. He said it would likely be months before the government can move forward with the primary care services phase.
Deputy Chief Medical Officer and NHI Project Manager Dr. Delon Brennen admitted on Friday that a delay in the implementation date of this phase is possible, given the lag in the first two phases of the program, registration and enrollment.

Brennen, who was a guest on Guardian Radio 96.9 FM's radio talk show "The Revolution" with host Juan McCartney, was asked whether that implementation target can be met, given numerous outstanding components, including insurance companies and doctors still not having come to terms with the government about NHI, and phase two not having yet started.

Last month, the CPSA, along with the Medical Association of The Bahamas (MAB), the Grand Bahama Medical and Dental Association, the Bahamas Doctors Union (BDU) and the Bahamas Association of Family Practioners demanded that the government respect the views of stakeholders and come up with an NHI plan that all stakeholders can buy into. They warned that doctors would not sign onto the scheme unless their concerns are addressed.

Asked yesterday if the CPSA's concerns have been addressed, Munroe said some doctors remain concerned. However, he acknowledged that the NHI Secretariat has been more engaging.

"There is more to be desired," he said. "Some doctors are more comfortable now, but we are still holding the position that we have to have significant input. But I can say that the NHI Secretariat [has] been more willing to have discussions with physicians."

Asked if the doctors are ready to sign onto the scheme, Munroe said, "A little more needs to be done before support is given."

He said the doctors' sticking points are reimbursement and capacity strengthening among other issues.

"Right now, I can say to you that we are trying to work out a fee schedule," he said.

Brennen acknowledged on Friday that if the doctors don't sign onto the program, NHI would be "in trouble". He also acknowledged that the implementation date may have been too aggressive and admitted that the secretariat is unclear when enrolment will begin.

National Insurance Board (NIB) Senior Deputy Director Cecile Williams-Bethel acknowledged recently that the registration component of NHI cannot ensue until NHI legislation is passed to allow NIB to share information about its registrants with the NHI Secretariat.

Munroe said while registration is ongoing, the government must place more emphasis on educating the public.

"I mean, I see Popeyes, McDonalds, Bamboo Shack, they all have ads out there," Munroe said. "Where are the ads that the government is putting out there to tell the Bahamian people and inform them and encourage them to be healthy?"

In the past few weeks, the secretariat has held several town meetings, but Munroe maintained that it must go further. He said it is equally important for the government to release the legislation and regulations that would govern NHI.

"The bill needs to be out there so that people will understand how this is going to impact them," he said, adding that the government must also be open to making adjustments to the bill based on public feedback.

Cabinet has approved the draft legislation that would provide the foundation for NHI but the government has yet to table the bill in the House of Assembly. The accompanying regulations have not yet been finalized, according to Brennen. Brennen said while there are still many unanswered questions, it's too early to say for sure whether the primary care services phase will be delayed.

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