Key National Health Insurance (NHI) providers have yet to be paid for medical services provided to thousands of Bahamians during the first two months of the Government's 2025-2026 fiscal year.
Dr Michael Darville, minister of health and wellness, yesterday confirmed the delayed payments in response to Tribune Business inquiries and said his ministry is "actively working" with the Ministry of Finance to "expedite the release of outstanding funds" owed to private medical laboratories who have not been compensated for services provided to NHI patients for either July or August.
The minister, pledging that resolving payment delays that have dragged on for months is "top priority", also sought to reassure that "measures are being taken" to ensure providers will be paid in full and on time moving forward although he did not provide specifics.
Dr Darville spoke out after the NHI Authority, which oversees the government-run and managed initiative providing healthcare for more than 161,000 Bahamians, informed laboratory services providers - who analyse blood, bodily fluid and tissue samples to determine what is wrong with a patient - that the monthly government subsidies which finance the scheme have not been received.
N. Gabrielle Bastian, the NHI Authority's primary care provider and strategy manager, in a message to laboratory services providers conceded the scheme is still suffering from "financial constraints" and the taxpayer subsidies that are critical to its financing remain "outstanding".
"We are writing to inform you that the July payment remains delayed and, as we approach the end of the month, August's payment is now due," she told providers in a missive obtained by Tribune Business. "Unfortunately, our monthly subventions are still outstanding, which has prevented us from proceeding with essential payments to you, our valued providers.
"The Ministry of Finance is fully aware of our current financial constraints, and is actively working to release the necessary funding to meet our obligations. We understand the impact this has on your operations and sincerely regret any inconvenience caused.
"Please be assured that we are maintaining close communication with the ministry and will notify you immediately once the funds are received and payments are scheduled." Christy Butler, the NHI Authority's managing director and chief executive, did not return a Tribune Business call seeking comment despite a detailed message being left with her office.
However, the delayed July and August payments again mean that private sector healthcare providers are financially carrying, and effectively underwriting, the government-run NHI scheme at their own expense, which is likely causing cash flow, liquidity and other financial strains for their own companies - including having to take on increased overdrafts and other debt financing to pay their expenses.
One affected provider, speaking on condition of anonymity, confirmed that "all of the above are impacted" when it comes to the financial fall-out from delayed NHI payments. Affirming that August's reimbursement, as well as that for July, is now due, they challenged how the Government can seek to expand the scheme when it cannot pay its present bills.
And, while "withdrawing services" provided to NHI would be "the next step" for providers to take if the non-payment persists, they suggested there was little appetite among the medical community for this especially given the potential impact on Bahamians and their ability to access affordable healthcare.
"It's definitely not sustainable for anybody," the provider warned of the current situation. "They're talking about expanding NHI and expanding the provider network, but they can't pay their patients now. Nor do they have a formula on what they're actually going to do with this new service they're planning on launching, which is associated with the insurance companies providing a basic health package."
That is the standard health benefit (SHB), which was passed by Parliament along with other reforms to the existing NHI Act, and is designed to provide all Bahamians with a minimum level of healthcare and benefits. The provider, meanwhile, saying they were uncertain on whether NHI is current with payments to doctors, affirmed that compensation delays have now dragged on for six to eight months.
"If you don't have money coming in, how can you have money going out when there's such a delay, especially on such essential services," they added. "Laboratory is pretty much a component for every patient. The cost of staff, cost of equipment, cost of agents is high. They [the Government] don't understand it.
"Other than withdrawing services, which would be the next step for healthcare providers to take, if it gets to that... but I think the MAB (Medical Association of The Bahamas) will be unable or unwilling to back such activity. I don't think the leadership at the MAB has the wherewithal to make that type of movement." There is no evidence to suggest quality of patient care and access has been impacted yet.
Dr Darville, in his reply to this newspaper, acknowledged: "We are aware of the delays in payments to NHI providers and understand the impact this has on the dedicated professionals who continue to deliver essential healthcare services to our citizens.
"The Ministry of Health is actively working with the Ministry of Finance and the NHI Authority to expedite the release of outstanding funds. We deeply value the commitment of our healthcare providers and assure them that resolving these delays is top priority.
"Measures are being taken to ensure timely compensation moving forward, and we remain committed to supporting providers for the vital care they deliver daily. We appreciate the patience and professionalism shown during this time, and will continue to provide updates as progress is made."
NHI is reliant on taxpayer funding as its sole source of financing at present. The latest payment delays come despite the Davis administration expanding the NHI Authority's annual funding by $2m in the Budget, increasing it from $46.2m to $48.2m for the 2025-2026 fiscal year - an amount projected to remain the same for the following two fiscal years.
For 2024-2025, NHI had used up $36.135m - some 78.2 percent of its full-year $46.2m allocation - by end-March, which marked the fiscal year's three-quarter mark. This suggested the remaining $10m was likely to be inadequate to see the NHI Authority through to the June 30 year-end, and the ongoing provider reimbursement issues are likely linked to the Government's wider liquidity and cash flow issues.
One NHI provider yesterday made such a link, adding that the delayed payments woes were unlikely to improve. "It's not going to get better," they argued. "How's it going to get better? There's no formula put forward to make it better. My concern is how far is this going to extend?
"We've seen it from a healthcare level, but how far-reaching is this, and how's it going to impact the ability of the Government to function?" Dr Duane Sands, the Opposition's chairman and a former minister of health himself, yesterday also connected the delayed NHI provider payments to the Government's "fiscal gymnastics" in an effort to meet its deficit and surplus targets for 2024-20265 and 2025-2026.
"Across the board there are serious challenges with accounts payables and I am not the slightest bit surprised," he asserted of the NHI situation. "The question is whether or not the efforts to meet the targets, the fiscal targets they have set, whether they will continue to maintain these payables.
"Whether this is fiscal gymnastics, you take your pick, take your parlance, but at the end of the day it's contrived and in no way does it translate into the level of fiscal security they claim exists. It is the manipulation of receivables and payables to achieve a particular outturn.
"The consequences for NHI, many of the vendors and, by extension, many of the persons that have to rely on the public health system, are they are having to finance the Ministry of Finance. They are unwilling creditors. They are a captive audience," Dr Sands added of the medical providers.
"They will have to determine whether to stop seeing patients, which is an awkward and unsustainable position for many people in healthcare delivery but many of the providers are challenged to maintain payments to staff, purchase supplies and provide services they are continuing to provide even when they can't get paid. Hopefully some of the vendors will get paid."
The Davis administration has repeatedly denied that the Government's finances are suffering from liquidity and cash flow woes as it strives to achieve a $75.5m surplus for the 2025-2026 fiscal year. It also needed to achieve a $71.7m surplus in June to hit its $69.8m deficit target for 2024-2025.