The National Coalition
For Health Care Reform

Article - 1st March, 2007

WHAT SHOULD BE DONE TO PROVIDE BETTER HEALTH CARE COVERAGE FOR ALL BAHAMIANS?
Find out where the National Coalition For Health Care Reform stands on the issues related to the proposed NHI!

The National Coalition for Health Care Reform (NCHCR) has repeatedly noted that it supports improvements to the health care system that will bring tangible and sustainable benefits to the Bahamian People. We are not simply about objecting to the creation of a National Health Care Plan. What we do believe however is that there is a better, more efficient, more effective way to ensure that Bahamian get access to the best possible health care at the best possible prices.

This series of articles will take an in-depth examination of the key principles of the NCHCR and demonstrate what significant issues we have with the current plan proposed by Government. We will also point out alternative approaches that we believe will lead to real and tangible improvements to the delivery of health care in our Country.

The Coalition is comprised of a wide range of organizations – from medical associations, to workers unions, to advocacy and research bodies, to private sector organizations. A casual look at our membership list would reveal the vast range of constituencies and viewpoints represented in the Coalition.

Therefore, at the outset of our exercise, it was important for us to agree upon the core principles and views that we share. These are encapsulated in our Statement of Purpose which articulates the eight guiding principles that we collectively agree should shape the health reform process in the country. So while our member organizations may articulate specific views and opinions that are in addition to the points highlighted in the Statement of Purpose, each member has subscribed at a minimum to the views expressed in the Statement.

Part One of the series highlights the first principle in our documented Statement of Purpose.

1. Upgrading the present health care infrastructure should be the first priority: The Bahamian health care system requires significant and sustained restructuring and reform which includes an upgrade to the physical, human and administrative infrastructure.

The Key Issues

The Coalition’s first guiding principle which states that priority must be given to the upgrade of the administrative and physical infrastructure in the public health care system BEFORE the full introduction of a National Health Insurance Plan.

The simple truth is that the current infrastructure does not have the capability to administer a national health insurance plan as proposed by government. The introduction of an NHI will INCREASE significantly the demand for health services in the public health care system. The physical plant of the public health system is already operating far beyond capacity, with housing, equipment and information systems that are woefully outdated and overwhelmed in many instances. The plants will not be able to accommodate the demand for services.

Without the upgrade of the physical and administrative infrastructure at the beginning of the process, the goal of improving the access will not be achieved. In fact, given the greater the demand push under a comprehensive plan, coupled with an already overburdened system, participants in the plan may find their access diminished as opposed to improved.

Recommendations (An Alternate Approach):

We recommend to the government that the initial step along the road to a National Health Insurance plan must encompass a thought-out and well articulated pre-implementation phase of the NHI. And despite protestations from some quarters, we are not referring to simply agitating for more talk and no action. Instead, we are referring to legitimate and sustained action that would bring much relief to overworked health professionals while increasing the access to and quality of health for our poorest, most needy citizens, even BEFORE NHI is implemented.

The doctors, nurses, orderlies and other health care professionals in our public health care system will tell you that we need to effect some very urgent short, medium and long term improvements to the physical infrastructure of the public health facilities if we ever hope successfully to meet the demands of a national health insurance system. They intuitively realize what studies all over the world have concluded: Whenever there is an introduction of public health insurance, there is an exponential growth in the demand for services.

What that will mean is that the current overburdened public health facilities will be inundated with a considerable increase of demand. Persons now holding their new NHI health insurance cards will descend in large numbers on the public hospitals for treatment that they otherwise would have neglected or delayed for lack of resources. They will show up at the very same hospitals which cannot handle the current demand.

Thus, we call on the government to design and execute a pre-implementation strategy that will make the necessary physical preparation for the increase in demand that would accompany the introduction of a national heath insurance plan. This MUST happen if the plan has any chance to succeed.

There is another important element that successive Bahamian governments almost always seem to overlook. That is the necessary total overhaul in management processes and structures that must accompany the introduction of any sophisticated, modern business practice in government. Our policy makers repeatedly seem to want to introduce the proverbial new wine into old and leaky bottles. Then the policy makers seem dismayed when the bottles rupture and their plans fall miserably short of expectation.

As stated earlier, a part of the problem clearly is the lack of resources. However, bureaucrats the world over will always scream to the policy makers about the need for more money; they will seldom employ that same gusto to call for the management reform that will overturn their beloved status quo. However, we are firm in our view of the necessity that a revolution in the approach to public health care management is an absolute necessity if national health care reform is to take root and produce tangible benefits.

To its absolute credit, the government’s very own Blue Ribbon Commission (BRC) Report realized this same very fact! As with the needed upgrade to the physical plant, the BRC report noted that there must be an absolute overhaul in the management of the public health care system. On page 106 of the BRC report you would note their observations that the current administrative framework is insufficient to implement and manage a NHI driven health care system. According to the Commission, the mechanisms for control, quality assurance, case file management and accountability are woefully under-developed.

(You do not have to take our word for this. In our commitment to fairness and transparency we have provided on our website all documents from the public sector that we have received, including the government’s BRC Report, so that all Bahamian residents can read the statements and views from all sides and make up their own mind.)

Again, to its credit, the BRC report did not stop simply with this criticism. It went on to detail close to 40 points of administrative reform that it states must be undertaken as part of an institutional strengthening project if the NHI is to be executed with some measure of efficiency and success.

Note that this is NOT the Coalition speaking, this is the very same Commission that was appointed by the Prime Minister and whose report was accepted. Thus, in the spirit of true collaboration, we are proud to say that the government’s Blue Ribbon Commission agrees with the Coaliton’s first principle as expressed in our Statement of Purpose.

We have asked the government for a report on their progress on meeting the 40 odd management reform recommendations proposed by the BRC report. To date, we have yet to receive the status report.

To summarize the recommendations of this Part one 1 of our series. We call on the government to:

• Establish and execute a pre-implementation phase that will make urgent upgrades to the physical and administrative capacity of the public health care system;

• Establish and develop a long term budget and funding options for the construction, outfit and maintenance of modern hospital and clinic facilities that will be able to reasonably accommodate the anticipated increased demand of a fully phased-in national health insurance plan.

Go forward to Part Two of this Series.