As the jousting between the Medical Association of The Bahamas (MAB) and the Bahamas Independent Providers Association (BIPA) continues into a second week, MAB President Dr. Sy Pierre has questioned whether BIPA leader Dr. Conville Brown and his associates are seeking to use "special privilege" to bypass the National Health Insurance (NHI) Secretariat.

Pierre also pointed out that the BIPA was not invited to be a part of any major stakeholder groups formed in the interim of the rollout of NHI.

Invited
"If BIPA is an established or possibly significant stakeholder, how is it that they were not invited to be a part of the Universal Healthcare Advisory Council established by the National Health Insurance Secretariat's office to address stakeholder issues?"

Pierre further expressed concerns about BIPA.

"MAB members are concerned that if the private, for-profit healthcare facilities form a virtual monopoly - by way of an IPA - on the provision of private and possibly public healthcare, what is the possible implication for Bahamian physicians?

"Are our highly trained and skilled physicians to be relegated to being employed serfs of these facilities? What will happen in the future when young Bahamian physicians look to come home and there are no opportunities for advancement?"

"As I have always stated, any group of providers should be free to form any sort of corporate body that is in line with the laws of the Commonwealth of the Bahamas. However, we should also be free to give constructive criticism of those bodies if there is opinion that they may not be in the best interests of The Bahamas," he said.

Privilege
The BIPA and its role in regards to NHI has been the subject of a public argument since last week. Brown issued a statement earlier this week in response to the criticism from the MAB, and said that eight organizations have signed onto an agreement in favor of an IPA.

Yesterday, at a press statement, Pierre pointed out that seven - not eight - groups had signed onto the BIPA agreement: the Consultant Physicians Staff Association (Nassau and Freeport), Grand Bahama Medical & Dental Association, Care Bahamas - a private managed care group, Physicians Alliance - a private facility/provider operation, Doctors Hospital - a
private facility, Sunrise Medical Centre-Hospital Complex - a private facility, and the Medical Pavilion Bahamas - a private facility. He also took note of comments made in Brown's press release.

For example, Brown stated, "An audience was sought with Prime Minister Christie to inform of our group's desire to have said model considered as a possible facilitator of implementation of National Health Insurance."

Said Pierre, "This is interesting - and possibly disturbing if a meeting actually took place - as the government of The Bahamas has specifically set up the office of the National Health Insurance Secretariat to deal with all matters NHI. Is Dr. Brown saying that his group has special privilege, able to bypass the normal processes and access the prime minister's office?"

An IPA is a North American model for an association of independent physicians and other healthcare providers that contract with the IPA to provide services to health insurance organizations on a negotiated per capita rate, flat retainer fee or negotiated fee-for-service.

Pierre asserted that BIPA would marginalize those providers who did not sign onto it.

He added, "BIPA may go bankrupt due to poor management, then where does that leave our patients? Who then is responsible for the potential millions of lost public money?"

With respect to the negotiation of contracts, Pierre contended that there is no need to have an IPA negotiate contracts, remuneration, etc., because a properly drafted fee schedule would guide remuneration.

In its defense, BIPA asserts that the IPA undertakes major functions for independent medical practices required to meet the standards of practice and benchmarks for care and diseases delivered in both the managed care and value based arena. BIPA says that, by using an administrative staff of its own, the IPA organizes the delivery of care.

Xian Smith, Guardian Business Reporter

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