Matters in Healthcare: How can small firms contain health care costs?

I’m a small business owner. It’s me and my husband, and we just cannot afford these skyrocketing healthcare costs. Our health insurance premiums cover major medical, but they still cost half of our income each month. As a business owner, I do not have the luxury of my company picking-up half of my insurance. This cannot continue so what is being done to stop these spiralling costs and how can we try to contain our expenditure on health?

Your situation is, unfortunately, increasingly common. The statistics we have show that more and more employers — especially small ones — are having greater difficulty in maintaining their health insurance obligations. You are on the right track by staying safe and within the law by keeping your insurance active. As a small business your options for premium reduction can include, considering other packages with your current insurer, who may offer more modest and economical plans; or you can shop around with other insurers to see what alternatives they may offer that are easier on your budget but meet your medical needs. You should always keep in mind, the option of Government’s HIP or other low-cost plans available where being a small group is not a disadvantage.

To curb the island’s health costs will take a wider, more concerted effort. Staying healthy will help in the long-term, and being careful about how we use services will help in the short-term. For example, appropriate use of the emergency department, diagnostic tests, hospitalization, overseas care and other high-cost care will help us all to bring our costs under control.

What is this about kicking sick seniors out of the hospital? Is it true?

Answer: It’s absolutely not true. The King Edward VII Memorial  hospital currently has some acute care beds with patients who don’t require this intense level of care. These patients need medical care, but not the around-the-clock care provided in an acute hospital ward. To assist with the situation, KEMH has been working to put in place alternative level of care wards for non-acute patients who cannot be discharged safely, and the Bermuda Health Council is working on extending the Standard Hospital Benefit so that, when patients are discharged, their home medical care can be covered.

I exercise and eat right, which can cost a fair bit of money. My gym membership alone is a few thousand dollars a year. I feel like I am doing my part to try to not incur further costs on the healthcare system by incurring my own independent costs (gym), so why do my premiums continue to skyrocket and why is a person who eats junk and sits on their bum all day paying the same? Is there some way to make this system more fair?

There’s a lot in this question. First, your concern about couch potatoes paying the same premium as healthy you.

Rest assured that this is not really the case. It is true that the premium for the mandated hospitalization insurance (the Standard Hospital Benefit (SHB)) is the same for everyone, but that is only part of your full insurance premium, which actually differs tremendously by group or individual policy — ask anyone over 65 what they pay for insurance, regardless of their health status and you’ll see your advantage very quickly.

The SHB is community rated (the same premium for everyone) because it’s intended to provide coverage for catastrophic health events requiring hospitalization. Most people agree that if someone has an accident or suffers an unforeseen health complication they should have access to and coverage for their care.

The problem comes in the way this coverage is used is exceeding its intended use and has become more costly than it should be. Work is underway to grapple with issues of waste and over-use, particularly with respect to inappropriate use of the hospital and diagnostic testing.

Secondly, I also have to applaud you for taking care of yourself. This benefits you personally in terms of your health status and quality of life, but it’s also good for the health system and, in a way, we all benefit.

Next, let’s address some common misconceptions. Exercising needn’t cost a lot of money. We can take up costly activities but with our climate and infrastructure, it’s also possible to stay fit at almost no expense. Everyone’s choices are respected — you have to do activities you enjoy so they are sustainable. But it’s always worth clarifying that exercising need not cost a lot. Likewise, eating right is not a lot more costly than eating junk. You would find that filling your shopping cart with healthy foods for a balanced diet with the right portion sizes, would not differ much from the cost of fast, processed and pre-cooked foods in the large quantities Bermuda loves to consume. A bar of chocolate or a bag of chips cost the same as a banana or an apple. Water is free but sodas are not. So eating right may feel expensive, but compared to other foods locally and the way we tend to eat, it isn’t really more costly.

Providing answers

Answers supplied by Jennifer Attride-Stirling, CEO of the Bermuda Health Council

The Bermuda Health Council and the Bermuda Sun have teamed-up to answer your questions about the island’s health care system.

Visit www.bhec.bm to submit yourqueries and look for our response in the Bermuda Sun on the last Friday of every month and on www.bermudasun.bm.