March 21, 2012

Dear Sir,

In the debate about healthcare and insurance regulation, I understand why people are all for eliminating what the Ministry refers to as “upfront payments”. They have paid their premiums. Why should they have to pay again? I get that. I’m an insurance card-carrying patient too. But after sitting through a few too many meetings on the subject and reading through the actual legislation, the bill just passed by the Government leaves the healthcare providers holding the bag again. Here’s an example of what I mean: As a healthcare provider, I can be fined for asking for the fee in full at time of service but there is no penalty on the insurance provider for not giving me the information I need to determine what the portion of the fee I can ask for at the time of service.

What the healthcare providers have been asking for is that this legislation not be pushed through without first implementing steps to make sure all information systems are fully operational. These steps should take place before any new regulations kick in to regulate healthcare providers. The key is to regulate the insurance industry first. If that is done, everything else falls into place information on patient coverage can flow on time to healthcare providers who can bill them accordingly. The system can then work to the satisfaction of all. I am not against the elimination of “upfront payments”. I’m on the side of my patients as I have always been. But this is an argument about making sure the system works. The legislation just passed by the House of Assembly imposes an August 1 deadline for industry compliance, just over four months from now. When you consider the fact that the Health Ministry’s committee for implementing this legislation thought it would take three to five years to get government and private insurance systems fully operational you have to wonder about the rationale behind the August 1 deadline.

It sounds good for the Minister to declare his impatience with the slowness of change, but he always had the authority to institute phased change to ensure the system worked for all concerned. In my books, that should be the Minister’s first responsibility. Now, we have a situation taking shape in which healthcare providers will be caught between a rock and hard place penalised if they ask patients for payment and private insurance and government insurance schemes that face no penalties for failing to provide them with patient coverage information. As things stand, healthcare providers are left holding the bag. With a little more care, this situation could have been avoided with all stakeholders put on a path towards system that works for one and all.

It strikes me that the Minister has put politics ahead of good policy, this is why:

There were two goals of this legislation

1. Regulate the insurance industry and

2. End the practise of collecting the insurance-covered portion of the fee from the patient.

There were two ways to approach achieving these goals

1. The way the government did.

2. The way the healthcare providers ask them to.

The way the government handled it scores political points for themselves and leaves the healthcare providers once again having to explain insurance coverage, financing and now this legislation to their patients. All the web sites and flyers that the ministry can produce will not replace the person to person explanation that will be needed at the time of patient’s health visit. Had the government listened to the healthcare providers, the health ministry’s goals would be met, and government wouldn’t be interfering with the doctor patient relationships. They just wouldn’t have scored the political points.

DR RONDA JAMES