PM Christie on NHI: My Govt Is Committed to Helping Bahamians Live Well

The Rt. Hon. Perry G. Christie
Prime Minister and Member Of Parliament For Centreville
On The National Health Insurance Bill
Monday, 15th August 2016:

Mr Speaker: The Government of The Bahamas is committed to the implementation of National Health Insurance so that every Bahamian has access to an improved quality of healthcare. NHI is indeed a financing mechanism to bring about Universal Health Care.

Mr Speaker, as the cost of health care continues to rise, we are not seeing a rising level of key indicators of health. Governments around the world are recognizing the importance of direct intervention to improve the health outcomes of their citizens. Many countries are resorting to National Health Insurance. We have crafted a model that we believe suits us best. And in spite of what you hear from some stakeholders we have listened to them.
To the extent, Mr Speaker, of incorporating a multi payer system, to ensure that the insurance industry remains a vibrant industry in our economy. The Government spends more than $100 million a year on private insurance premiums for a rather small percentage of public servants. We have made a decision, however, not to disturb the insurance arrangement that is in place today. So, for example, there is no intention to interrupt the private insurance coverage that the police and other members of the security forces currently enjoys.

Mr Speaker, NHI will allow persons to obtain care without going bankrupt or dying early and will, in addition, allow them to use their savings to invest in their and their family personal and economic development, NHI will improve the ability of health care providers to give the best care as a result of improved resource, and expansion and renovation of healthcare facilities, increase in manpower, primary healthcare specialists services at the community levels in NP and Family
NHI for example, Mr Speaker, will undeniably allow for mothers to have confidence that when they take their sons and daughters to their selected physician, that they will be able to receive a level of care that will follow the child or any individual from the initial visit to other levels of follow up care. This continuation of care is critical as we make access to health care affordable and accessible to all Bahamians.

This is no pie in the sky! Whether Members Opposite believe it or not, costs, whether real or perceived, frightens Bahamians from accessing the care they need to stay healthy. NHI is designed to remove the obstacle of costs from accessing health care services.

Mr Speaker, I draw your attention to the visual aid. The chart displays that today when a person accesses health care services there is a cost. These costs are far less in the public system than in the private system. To even get in the door in the private system, the patient is faced with the burden of cost. Just to register and see the doctor can cost you from $75 to more than $250.00. That does not include the labs, blood work and the diagnostic imaging that is required. At least consultation in the public system right now is free. However when a patient visits with a medical professional and there are required costs associated with laboratory services, imaging and some medications, the burden is placed upon the patient. Today this is the case. There is still a cost for labs, imaging and some medications, not covered under the National Prescription Drug Plan, albeit, far less as in the private sector.

This will no longer be the case with the introduction of National Health Insurance. National Health Insurance will eliminate that added strain on the individual and cover the costs for these services. This is a clear distinction between what currently exists and what will happen under National Health Insurance. Under NHI those costs will be removed, Mr Speaker. For Primary Health care in this initial phase of NHI. Mr Speaker, there will be absolutely no charge at the point of service.
Under NHI, Mr Speaker, everyone who enrolls in the NHI Plan, can go to their selected medical doctor, receive services and there is no question about a fee because the Government is now specifically directing the necessary financial resources for the patient to receive complete care at both public and private facilities. This is what National Health Insurance Bahamas is all about, access to services in both public and private health care facilities. This would allow persons who lack the ability to pay high private insurance cost to enter care and treatment early, which will result in early detection of potential or actual health problems.

NHI will ensure that Bahamians everywhere who require care “from the cradle to the grave” across the life span” from Inagua to Grand Bahama! Regardless of age! Gender! Color! Religious or Political affiliation will be guaranteed the right to attain and sustain the best quality of life and contribute to national development. Let’s take a walk with Barbara through the system of health care today:

Barbara (an average Bahamian) accesses a public health clinic (or hospital) and must pay a registration fee to see a doctor; this doctor may change every time she accesses the public health system).
We acknowledge that this fee may be waived in the public system for persons who clearly lack the funds to pay the registration fee.

Barbara, does not have an appointment and may have to wait hours in order to access medical services.
A doctor in the public health system, has to try their best to quickly get up to date on the patient’s (Barbara’s) medical records (which may not all be centralized at that facility).

The doctor examines the patient and informs them that they must receive an X- ray of their ankle.
Barbara receives a requisition to have all of these tests carried out, along with a prescription to deal with the pain.
Barbara does not have the funds pay for the prescription, diagnostic tests or x-rays. These funds are not waived.
Barbara must find the funds to access these services or neglect getting further care – which may deteriorate into a catastrophic illness.

Private Sector
Barbara accesses a private health clinic (or hospital) and must pay a registration and for every service she is required to get to keep her healthy.
Under NHI

Barbara, a Bahamian enrolled under NHI Bahamas, is able to make an appointment with her primary care doctor (who is responsible and focused on monitoring her health).
Barbara’s primary care doctor can be in the public or private sector, and she is able to see her doctor in a timely fashion.
Barbara’s doctor has more time to focus on her needs and keeping her at the centre of care.
They recognize that she needs an X-ray and to encourage preventative care, notes that it is now time for her to have a mammogram and Pap smear.

Barbara is referred to a radiologist to receive an X-ray (no payment required from her) and doctors (gynecologist?) to receive her Pap smear and mammogram.
Barbara is able to access a pharmacy in the public or private health care system to get her medication.
Her records are centralized with her primary care physician. Barbara gets a call from her PHC provider to review her results and determine any future course of action and encourages the rest of her family to get their annual physicals.
Barbara is receiving thoughtful, consistent people-centre care under NHI and must no longer have to worry about finances being a barrier to her access to care.
We are doing something different – NHI Bahamas is leveling the playing field between public and private health services in The Bahamas.

Another point of critical importance Mr Speaker is air transfer for our Family Island countrymen and women. And again as a cautious reminder to Central Grand Bahama, the philosophy between out two parties cannot be more different. The mother in Mayaguana with a complicated pregnancy, or the father who is experiencing significant breathing issues should not have to depend on MASA or find the money to airlift them to Nassau to get the requisite care under NHI. These services are built into the cost of NHI. You shouldn’t have to die if you live in Acklins and you cannot afford the cost of being airlifted. You have every bit of right to access the services needed to keep you healthy no matter where you live.

Mr Speaker, there is a lot of talk from the Members Opposite about why we have decided to roll our NHI with Primary Health Care. Apart from this being the considered advice our Consultants, based on the recommendations by the World Health Organization, and reiterated by the Pan American Health Organization, Primary Health Care as a first stage makes logical sense and maximizes the use of our scarec resources for long term benefit. The purpose of primary care coverage is rooted in the following three areas that include promotion, prevention and care. We will aggressively seek to improve the overall health and well-being of Bahamians by promoting healthy behaviors and creating supportive environments for people to increase control over their health. Currently, we have Bahamians visiting our medical facilities when there is a health concern and need to see a doctor; however, we are seeking to promote healthy behaviors so that Bahamians better understand the importance of taking care of themselves in partnership with their own selected medical doctor.

There will be no taxes placed upon Bahamians as we introduce primary care coverage. The budget allocation of $100M is being effectively used from our existing healthcare spending investments. We will be managing these funds more effectively to eliminate waste that is as a result of a system that requires better governance to improve the quality of care available to Bahamians.

The importance of medical services to maintain and improve health is a key tenet of primary health care that will be delivered through National Health Insurance Bahamas. We must address the common health conditions of Bahamians so as to be able to allow them to live and lead longer and healthier lives. We must drill down on strategic initiatives that will begin to make a dent on our high incidence of diabetes, among the highest in the region, hypertension, infant mortality cancer, particularly breast cancer.

Non Communicable Diseases(NCDs} put a significant burden on our health care system. And for the most part these can be avoided. But if intervention is not early and thorough they can lead to serious secondary and tertiary medical maladies.
The importance of prevention is critical. The adage “An ounce of prevention is worth a pound of cure” is one that resonates with all of us. While Bahamians utilize our healthcare facilities currently, we must do a better job of taking measures to prevent illness and disease and to better position persons for a healthy future. The Government of The Bahamas will care for the whole person with a level of care and through access to services that undoubtedly will help all Bahamians to have access to the screenings, counseling and immunizations necessary to lead healthy lives.

Mr Speaker, in his contribution, the Minister of Health described a series of health systems measures that the Government has initiated or about to initiate in anticipation of NHI.
We are moving in earnest to open and make fully operational the new facilities in Abaco and Exuma. Exuma is already operating 24 hours a day seven days a week. And the full potential of these facilities in Providing care and the quality Of life for our people is yet to be realized.

Once fully operational these polyclinics will provide a wide range of Primary and Primary Specialist services! On site Laboratory, X- ray, Ultra Sound and ECG, In-Patient admission for selected conditions for up to (2) days Once fully opened and operational the new facilities in Abaco and Exuma would allow for selected minor surgical and other specialist services either by telemedicine or in the Facilities on a sustained scheduled basis. With Other islands and cays also benefiting from the services to be provided by these regional polyclinics, many services will no longer require referral to Princess Margaret Hospital.

Secondly, my Cabinet has recently approved the design of a new Women’s Hospital and a revamping of the Accident and Emergency section of PMH.
In addition,
• We have already hired two additional health educators who are also Laboratory technologists and we are presently reviewing application for an additional 4 Laboratory technologists.
• We will hire 5 additional radiographer for posting to the Family Islands where x- ray machines are functional.
• By increasing the number of nutritionists! Health educators! Other allied healthcare providers and new categories of workers to Mount an aggressive health education and disease prevention program.
• Acquisition is in train for a new mammogram machine for Eleuthera.
• Acquisition of a new Medical Record System.
• We are moving towards an enhanced governance structure by reorganizing the health services delivery in the public sector into a Single Governance entity, combining the Public Health Authority and the Department of Public Health toes to ensure efficiency, minimize wastage and better utilized funds.
Mr Speaker I have made a commitment people that they will see a dramatic difference in the delivery of health crew services and the condition of the healthcare infrastructure as we rollout NHI.

My Government recognizes that there are some services and medications already available to Bahamians in times of sickness; however, National Health Insurance Bahamas will remove the ambiguity and uncertainty of what individuals will have access to. National Health Insurance Bahamas will clarify that all legal residents of The Bahamas have access to all primary care services at no cost.

We must not allow ourselves to get lost in the disappointing rhetoric that we are already deliver primary health care coverage at no cost. Rather, we must look forward to ensuring that every single Bahamian has confidence that they no longer need to choose between addressing their primary care medical needs versus covering other expenses. Through the implementation of National Health Insurance, the single mother in the Berry Islands can walk into an approved facility to see her doctor regarding a primary care need and know with confidence that she is benefiting from a modern, affordable and accessible health care system.

Notwithstanding our current state of affairs, we must most forward towards health systems strengthening that will position us to create a better state of affairs for all Bahamians. My Government is committed to health systems strengthening and within the coming months and years we will boldly address the areas of governance structures so that our public clinics and hospitals will have increased efficiency, coordination and cooperation. We will continue to give attention towards the improvement of our facilities throughout the Family Islands.

Through our adoption and promotion of the People Centred Model, we will ensure that the Bahamian patient is at the core of our services. With the individual Bahamian at the core, we will promote health education, shared care plans and personal care coaching. These three areas reflect what we must consistently do to improve the quality of life for Bahamians.
And diseases prevention services .which empower people to make healthier choices which will improve the quality and productivity of their life.

Mr Speaker, my Government is committed to helping Bahamians to live well and to access care while maintaining their dignity. We want to remove the stain of shame from the reality of not having the money to access the care you need to keep you healthy and alive, and from the fear of going bankrupt to access healthcare. Money should not deter you from accessing care Mr Speaker.

Comparisons of cost for various tests and labs
1 – CBC (full red blood test)
DPH – 15.00. Private -$25.00
2.- SMAC25 (full blood chemistry)
DPH- $75.00. Private- $95.00
3. SMAC 12 (more specific and recommended as first test)
DPH- $45.00 – Private- $75.00
4. Electrolyte – specific chemistry
DPH- $30.00 – Private- 58.00
5. Lipids – specific chemistry
DPH–$35.00 Private- $60.00
6.Renal Function – specific Chemistry
DPH- 40.00 – Private-$70.00
7. Liver Function- specific Chemistry
DPH- 45.00 Private- $63.00
8. Blood Glucose- specific Chemistry
Random finger prick $2-300.00
DPH- $7.50 – Private- $20.00
9. VDRL (test for syphilis)
- DPH- $10.00 – Private- $35.00
10.- Blood Grouping.
DPH -$10.00- Private-$53.00
11.Sickle Cell
DPH- $10.00 Private- 25.00
DPH… Free for all pregnant women. Trying to secure formal written policy for all Sexually transmitted infections to be free. $25.00 Private.
13. Urinalysis
DPH- $10.00 Private $25.00
14. Urinalysis Culture
DPH- $25.00 Private $-
15.Direct Coombs Test (for blood rebus compatibility)
DPH- $25.00- Private- $55.00
16. Indirect Coombs Test
DPH- 25.00- Private- $65.00
17. HbA1c blood sugar test to show control over 3 months)
DPH $20.00/ Private-$79.00
18. PSA (prostate)
DPH$35.00- Private- $70.00
19.stool test
DPH $10.00- Private $40.00

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