Healthcare professionals reject NHI

Wed, Apr 13th 2016, 11:57 AM


The United Healthcare Reform Alliance (UHRA) yesterday released 10 points, one of which is a demand for "proper and meaningful consultation". Dr. Charles Clarke, president of the BDU addresses the room with CPSA President Dr. Locksley Munroe to his left and Dr. Sy Pierre to Munroe's left.

Calling it "a very expensive and disruptive exercise in futility", a coalition of nine professional groups yesterday flatly rejected the Christie administration's proposed National Health Insurance (NHI) model, charging that the challenges in the healthcare system have their origins in public healthcare administration. The group also pledged to present an alternative to NHI and warned that it would be engaging a lawyer to conduct a comprehensive review of the "significantly flawed" NHI Bill.

The United Healthcare Reform Alliance (UHRA), as the 2,000-member coalition is called, yesterday released 10 points, one of which is a demand for "proper and meaningful consultation".

The members of the UHRA will not sign on to NHI as proposed by the government. The alliance has stated that it demands proper and meaningful consultation with its members, and said that its stakeholders must feature prominently in the governance structure of the UHC scheme. The UHRA has undertaken to present an alternative and workable plan to the government.

Also according to the 10 points, the UHRA has serious concerns about the draft NHI Bill.

"In particular, we are troubled by the extensive powers of the minister, the intrusive powers of the proposed NHI Authority, the deficient governance structure of the program and the potential impact of the legislation on the privacy and protection of personal data of persons. The UHRA will be engaging legal counsel to conduct a comprehensive review," said outspoken CPSA President Dr. Locksley Munroe.

Yesterday, the UHRA held a press conference at which the group of healthcare professionals presented its refusal to sign onto the NHI program and came together to present an alternative plan for universal health coverage (UHC).

10 points on UHC

The other points include the UHRA's support of the concept of UHC.

"We believe that universal healthcare currently exists in The Bahamas, but it needs to be improved and expanded. The flaws in the existing system are concentrated mainly in the public health sector," the UHRA said.

Also, the UHRA is of the view that UHC must be affordable, sustainable and bring about minimal disruption to the healthcare system and the economy.

"The UHRA consists of world class professionals with the expertise and experience to design and implement an appropriate UHC model for The Bahamas.

In addition to rejecting the NHI model proposed by the government and its consultants and denouncing the perceived level of disrespect and disregard toward professionals in the Bahamian healthcare sector in the NHI discussion to date, the UHRA submitted that the challenges in the healthcare system have their origins in public healthcare administration.

"It follows that the remediation and expansion of the system must commence with the strengthening of the public healthcare system. Significant upgrades to the public healthcare system, electronic medical records and greater operational efficiency must precede the implementation of an appropriate NHI model," the UHRA said.

Another point was that the expansion of UHC and implementation of NHI must not be tied or linked to a political agenda or election cycle. The timeline established for implementation is unrealistic and inconsistent with international best practice, the alliance asserted.

Also, the UHRA said, "There is no need to establish additional government entities at the expense of taxpayers. The UHRA opposes the duplication of efforts and creation of multiple layers of bureaucracy in the expansion of UHC. The focus must be on patients, not on government red tape or the expansion of the public service.

"The UHRA does not support the creation of a public insurer. Rather, the existing legislative and regulatory frameworks for private health insurers should be enhanced to ensure greater transparency, accountability and efficiency. The government should maintain its traditional role as regulator and not engage in private enterprise," the alliance said.

Bona fides
The founding organizations of the coalition are: the Medical Association of The Bahamas (MAB), the Consultant Physicians Staff Association (CPSA), the Bahamas Association of Physiotherapists, the Bahamas Doctors Union (BDU), the Bahamas Association of Medical Technologists, the Bahamas Association of Primary Care Physicians (BAPCP), the Bahamas Psychological Association, the Bahamas Insurance Association and the Bahamas Insurance Brokers Association.

The UHRA says the proposed NHI model is flawed and unsuitable for The Bahamas, and that the draft legislation was developed without authoritative input from local professionals and is "significantly defective".

The new body has pledged to ensure that UHC is done right and has committed to providing the government with an alternative plan for realizing "practical, sustainable and meaningful" UHC in The Bahamas. Principals of the coalition are advocating for the preservation of customer choice, improvements to public care facilities, limits to the expansive powers assigned to the minister responsible for NHI, informed fiscal planning, and a commitment to data protection and corporate governance that addresses the interests of all stakeholders.

Outrage
BAPCP Vice President Dr. Carnille Farquharson said her members have repeatedly asserted their support of UHC, and seek to ensure equal access to essential primary healthcare services and quality in the delivery of those services to all legal residents.

"However, we also believe it is vital to preserve the element of choice in seeking to implement a National Health Insurance system. And we are confident, as a group, we can formulate a proposal to achieve universal health coverage with minimal cost and disruption to our economy. We want to see every eligible person covered; we want the system safer and more efficient. Our government should want the same thing."

Dr. Charles Clarke, president of the BDU, said that private medical facilities have outpaced their public counterparts in providing quality and timely medical service.

"We have witnessed significant deterioration in the public healthcare infrastructure in The Bahamas due to inadequate funding and a poor maintenance culture. This must change if we are to expand universal healthcare in The Bahamas. While we note that the government has committed to strengthening the public healthcare system in the coming months and years, this process will take time and must be properly planned. Additionally, the human resource component needs more attention in order to improve the delivery of healthcare in the public sector and obtain better healthcare outcomes," Clarke said.

Meanwhile, Munroe also noted his "extreme disappointment" that the government's recent decision to stay the NHI implementation process only came after expending "considerable time and taxpayer dollars" on counsel from outside consultants, despite caution from industry professionals against this impractical timeline for more than a year.

"Moreover, the fact that the bill has been delayed with no concrete timeline for tabling in the House of Assembly suggests that this has been a very expensive and disruptive exercise in futility, with the government only now realizing the shortcomings of the proposed model, bill and the entire process. The omission or deliberate exclusion of key stakeholders from the new governance structure for NHI suggests that the government has not learned from its past mistakes. The reality is that exclusion and antagonizing partners will only further divide us and set us back. It is time for the government to look within and listen to the professionals that can really help in our UHC journey," Munroe said.

By K. Quincy Parker

Guardian Business Editor

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