The National Health Insurance Authority (NHIA) has proposed a fee-for-service (FFS) mechanism that would change the way physicians are compensated, according to NHIA Chairman Dr. Robin Roberts.
Roberts’ comments follow a withdrawal of services by more than 100 senior physicians throughout The Bahamas due to concerns about their working conditions, a lack of health insurance and a salary increase.
In a recent interview with The Nassau Guardian, Roberts said, “National Health Insurance is how we can have a financial system that is sustainable, how can we provide a package of services that we can afford and how can we provide a system that is reliable to produce what it says it’s going to produce, and that is better care and…value for money.
“So, what we are saying is National Health Insurance will change the reimbursement mechanism for both the institution to collect its funds and for the physicians and nurses to be paid because there will be more funds available.
“So, we are looking at it from the institution point of view, if all those who are employed have an employee mandate where they are covered with health insurance, and all the remaining population, the other employed, our senior citizens, our children, are covered by the government service…it means that every patient then, or every patient in The Bahamas is a private patient essentially, because they have their individual insurance coverage; so the institution can now bill for the services provided to each person, so it can better its services.
“We are saying very clearly that from a physician reimbursement mechanism…one of the mechanisms we should look at is a fee-for-service mechanism, and a fee-for-service mechanism means an activity-based mechanism; so if you work, for every patient that you see and you treat, you will be compensated.
“Now we can determine what that level of compensation means, we can take into account the volume of work we’re doing, but I think we’ll put in place a mechanism to which the physician feels that there is some worth for everything that they do.”
As of Friday, the Consultant Physicians Staff Association (CPSA) and the Public Hospitals Authority remained at an impasse with no progress in their negotiations over a salary increase.
Senior physicians initially requested $250,000 annually as a base salary, but CPSA President Dr. Locksley Munroe said they are willing to accept $75,000.
The PHA’s most recent counterproposal would have increased the base salary from $48,000 to $60,500.
But Munroe maintains that the offer was unacceptable.
The union is scheduled to meet with Prime Minister Dr. Hubert Minnis today to discuss the matter.
Asked whether the NHIA has discussed the new compensation mechanism with senior physicians, Roberts said, “We are in the discussion phases of what national health can offer, and I can say that in our preliminary discussions with our senior physicians, so far we’ve talked with the executive of the medical association, the executive of the consultant staff association and this is something that they feel that can work, that these are areas of new means of reimbursing physicians that they feel can provide the kind of incentives for physicians to perform well, and so yes it’s very positive from an NHI point of view.”