Accused by the United Healthcare Reform Alliance (UHRA) of disrespecting Bahamian expertise and altruism in the healthcare sector, the National Health Insurance (NHI) Secretariat yesterday took a conciliatory tone, but nonetheless insisted it has been incorporating stakeholder input "as much as possible". The issue turns on the view of the alliance that the administration is placing greater value and emphasis on advice from foreign consultants than local professionals.
The UHRA is a 2,000-member coalition of healthcare professionals including doctors, insurance personnel and medical technicians which has flatly rejected the administration's NHI model, and has chosen to move forward as a block, rather than as individual stakeholder groups.
Noticeably absent from the alliance is the Bahamas Nurses Union, but Guardian Business understands that the BNU is in discussions with a view to possibly joining the UHRA.
Engagement
Regional director for Generali Worldwide and Bahamas Insurance Association (BIA) spokesperson Tina Cambridge told Guardian Business yesterday that the healthcare sector wishes to speak with one voice on this issue.
"This is how our conversation started. None of us were willing to sign on to the model that is currently being pushed through by the government. That means that all of the stakeholders - you don't have any medical stakeholders, you don't have any insurance administrators, you don't have any of that - because we still need clarity as well," Cambridge said.
She said the alliance would put foward "what we think, as Bahamians, as professionals who have the expertise and the systems in place as private entities collectively, to make this happen properly for The Bahamas".
Cambridge also spoke directly to the question of engagement.
"The government engaging us? They will have to engage us as the UHRA. None of us are going to speak outside each other. Because we have been, over the past year and a half, we have had times when they have gone to each faction and tried to pick them off. We still have not gotten
"The Bahamian people should require that our administrators provide us transparency and the details to ensure that the system we are coming up with is going to work for each and every one of us," she said.
"This is not about our private enterprises and profits."
Disrespect
Meanwhile, Dr. Carnille Farquharson pointed out that her association - the Bahamas Association of Primary Care Physicians (BAPCP), of which she is the vice president - is particularly keen to have its voice heard given that the scheme is supposed to begin with primary care.
She took issue with the picture painted by critics of the outspoken professionals, many of whom - even up to the level of Cabinet ministers - accuse the doctors of being "greedy" and motivated by profit. Farquharson pointed out that with regard to physicians in the public health sector, particularly junior physicians, who have spent 10-plus years training to get to where they are, "There are likely executive secretaries in BEC that make more money than a senior house officer or a registrar working 60-70 hours per week in a healthcare system that can at times be missing personnel, equipment and medical supplies."
She added, "You have private physicians who straddle both public and private, and will use their private resources to benefit the public patients. We are not greedy and grabalicious, especially not those who are confined to the public healthcare system," she said.
"Government physicians - we laugh about it all the time, what people make in the government system as a physician, compared to other sectors - BRIT, BEC, people in those sectors make more than doctors," she added, noting that it was "disrespectful" to be called greedy and to be told their objection to the scheme is based solely on how it will affect doctors' bottom line.
Farquharson said the alliance prevents the administration from playing the different groups against each other.
Consultation
Meanwhile, the NHI Secretariat released a press statement yesterday asserting that it has been meeting with the UHRA groups regularly over the last several months and values their input.
"In fact, since the release of the draft NHI legislation on February 18th, the NHI Secretariat has redoubled its efforts to communicate with key industry stakeholders as well as the general public to gather feedback on the proposed NHI Bahamas model in an effort to strengthen and clarify the draft bill. The draft bill is still under revision, with comments from stakeholders being considered in the final drafting," the statement states.
After extending an invitation to the alliance to engage in "meaningful and constructive dialogue", the secretariat insisted that it has been addressing challenges and concerns raised by stakeholders as part of the NHI Bahamas rollout, including ensuring the program operates with several key things in mind including choice, continued improvement of public healthcare facilities, data protection, prudent and realistic fiscal planning and changes in the governance structure.
"Bahamians can choose both their registered and certified doctor and insurance provider. They can stay with their current physician if they wish, or they can choose another primary care provider," the secretariat said, adding, "We have been working hand in hand with the data protection commissioner's office to ensure that sensitive data under NHI Bahamas is treated and protected in the proper manner. All provisions in the draft bill are in line with international standards on data protection.
"The government has done its own financial estimates for the primary care phase of NHI Bahamas, and this figure has been validated by KPMG Advisory Bahamas, which continues to be engaged in rolling out the program in a fiscally responsible manner, and assisting with costing for the full program's implementation.
"The government is in the process of finalizing the Programme Board, as recommended by KPMG, that will include private sector membership in an integrated governance structure. This mechanism is consistent with international best practices in governance," the statement states.
By K. Quincy Parker
Guardian Business Editor
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