Common Ground On NHI:

By Candia Dames -
Nassau, Bahamas:

A well-respected physician who is a member of the National Coalition for Health Care Reform said Tuesday that National Health Insurance should be implemented now, but Dr. Duane Sands raised serious concerns about the present proposal for NHI.

Dr. Sands, who was one of five guests on Love 97’s "Issues of the Day" with Wendall Jones, suggested that the drafters of the National Health Insurance Plan were not being completely honest with the Bahamian people, but it’s a suggestion Dr. Perry Gomez, who is a chief engineer of the NHI proposal, scoffed at.

Dr. Sands insisted that the specifics of the proposed plan have yet to be revealed, and he added that there was not proper consultation.

"I have absolutely no problem with a National Health Insurance Plan," Dr. Sands said.

"I think it should happen now. I think we need to make dramatic changes in the way healthcare is delivered. We need to improve access for our Bahamian people, but I’ve gone on record, and I go on record today, as saying this plan as currently touted will not do what it’s intended to do, and more importantly, I believe that we’re not terribly far off from the proponents of the current [proposed] National Health Insurance Plan.

"I believe that there’s enough talent in this country that if we sit down together and hash out the differences we can all develop a National Health Insurance Plan which we can be proud of, which would be sustainable and which would achieve the noble goals set out by the Blue Ribbon Commission [on National Health Insurance]. We’re not terribly far off."

Dr. Gomez insisted – as Minister of Health Dr. Bernard Nottage has done consistently – that there was widespread consultation before Prime Minister Perry Christie took the National Health Insurance Bill to the House of Assembly two weeks ago.

"There were consultations all along," said Dr. Gomez, who chaired the Blue Ribbon Commission. "The Blue Ribbon Commission, we had town meetings. We met with all of the stakeholders. Most of them were a part of the Commission to start with. We had them come in and speak with us as a Commission…and so you understand why I say it surprises me when people say there was no consultation because it was born in consultation."

But Dr. Sands said, "Consultation is not information giving; consultation is not outlining a plan; consultation is a back and forth exchange of information, ideas [and] views with ultimate compromise to the greater good of the nation."

He said government officials and others responsible for putting together NHI have put a spin on the whole issue, which he said was "disingenuous and almost dishonest."

"For instance, we’ve come with this wonderful sounding concept of cradle to grave. It’s all inclusive. It’s to provide benefits that are available in any private health care plan, at less cost than you can get it in a private health care plan, and quite frankly that is not possible. It is not possible," Dr. Sands said.

"There will be limits. There are specific questions that have to be answered like: Will the National Health Insurance Plan provide generic or brand name medications? If I want brand name medications how much would I have to pay for them and where would I get them from? If I’m to see a specialist do I have to go through a gatekeeper? And what if I don’t like that gatekeeper’s view?

"Are we going to set limits? Let’s say that I’m 75 years old and I need a kidney transplant, are we going to allow a kidney transplant for a 75 year old? We have to set some limits."

Dr. Sands said these kinds of issues impact on whether NHI will be sustainable.

"They impact tremendously the decision making process that reasonable human beings in this country must go through," he said.

Dr. Gomez then explained, "Whether you give a kidney transplant to a 90 year old or a 40 year old is a different issue. In principle we will pay for kidney transplants, but that goes to the practice of medicine, not every 90 year old should receive a transplant."

He also explained that the costing for the plan makes provision for an expected 20 percent increase in demand for health care under the advice of consultants who helped the formation of the plan.

But Dr. Sands insisted that the utilization of health care will be far greater than 20 percent.

"[The estimate of a 20 percent increase] will be shown to be pure, unmitigated rubbish," he said.

"It is definitely going to be far more and understand that you cannot have both sides of the fence. If you’re saying that the reason why we need this plan is that this unmet need [for healthcare] is of such dramatic social significance that we have to come up with this huge national policy, then on the flip side of it, it is going to impact utilization tremendously. And so it’s not going to be 20 percent. It’s going to 50 to 100 percent."

Dr. Gomez questioned on what basis Dr. Sands could come up with such an estimation.

Dr. Sands said similar utilization estimations in Canada, Great Britain and the United States all proved to be "totally off".

"The Blue Ribbon Commission, the working committee (on NHI) and the Ministry of Health estimate that this plan is going to cost $235 million. I would suggest to you, Mr. Jones, that it’s going to cost 300, 400, 500, up to 600 million dollars annually," he said.

Dr. Sands added, "There’s a lot of economic data that shows that the same way that I am waving my hands in the air to try and come up with a figure, the Blue Ribbon Commission did exactly the same thing. They waved their hands in the air and they came up with a number that has no basis in fact."

Dr. Gomez shot back, "Now that’s rubbish. That’s rubbish. You really shouldn’t come here talking foolishness."

Stanley Lalta, the NHI project manager, who was also a guest on the weekday programme, said the team of persons who worked on the numbers categorically denies Dr. Sands’ view that they waved their hands in the air and came up with numbers.

He explained that there was careful, scientific analysis of data which led to the various estimations.

"When you look at the data for example, we found that on average Bahamians were making 3.2 visits to their general practitioners on an outpatient basis," Mr. Lalta said.

"We did not think that when we compared the data with Barbados and other similar countries that that is what the level should be or will be as a result of NHI so we’ve bumped that up by adding this 20 percent increase or about 4.2 visits and this will not happen in one year. This is something that will happen over three or four or five years."

Mr. Lalta said as far as he is concerned, the capacity issue is not a big hurdle.

"What you have is a plan that makes provision for a strong public sector and a strong private sector, and I would think that the combined capacity of both of these sectors should be adequate to deal with the expected demand on an NHI plan," he said.

"We have made provision for growth over time and capacity does not stay stagnant. Capacity will also be moving over time, both in the public as well as in the private sectors, so the issue of capacity is not the biggest hurdle."

Dr. Gomez, meanwhile, said that while there has been consultation there had not been an aggressive public relations push on NHI in the past because the officials and consultants were working out the details of the plan.

He pointed out that the bill took "time and work" and didn’t happen over night.

Dr. Gomez denied the suggestion made by Mr. Jones that the government was putting the cart before the horse in taking the bill to parliament. Dr. Gomez insisted that this was not so, repeating that there had been widespread consultation.

Also appearing on the show was Winston Rolle, another member of the National Coalition for Health Care Reform, who said one of the reasons why so many questions are arising about NHI is because the devil is in the details.

"The details are what have not been made available to us to look at as yet," Mr. Rolle said. "That’s what the issue is at this point."

Another guest, John Pinder, who is the acting president of the National Congress of Trade Unions, said that some union leaders are concerned about exactly how the plan is going to work, and whether they will receive access to private hospital care under NHI, rather than having to go on the public wards.

29 November 2006

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