Health system faces overhaul to combat soaring costs

Health Minister Zane DeSilva said it was the “humane thing to do” for the wealthy to contribute more of the costs so their fellow Bermudians can afford coverage.

Abolishing upfront payment at doctors’ offices and a health-check discount for people who stay fit are being discussed as part of the shake-up.

Mr DeSilva is in the process of an extensive consultation process over the Government’s National Health Plan, which has included 37 meetings in the last two months.

Expensive

He admitted there are some people, particularly among the business community, who had initial doubts about the project.

But he said most had been encouraged by the meetings and discussions to date.

He warned the most expensive thing to do is nothing.

Healthcare costs for 2009 were $558 million. Only the U.S. pays more per person.

Analysts predict that figure could rise to $1billion in 2016 unless changes are made.

Mr DeSilva said: “The people pay for it one way or another, whether it is through increased insurance premiums or taxes. We all pay now and will all pay later.”

He believes it is only fair that those who can afford a little more cover a larger share of the costs, saying: “We don’t want to have grandmother having to make a decision between prescriptions and groceries.”

The new plan aims to stretch Bermuda’s resources to make healthcare affordable for all.

Mr DeSilva believes that by promoting healthier lifestyles, cutting waste in the system and introducing new methods of financing, Bermuda can meet the rising demands of its population and control costs.

A key element of the plan is the concept of “proportional financial burden”.

The standard hospital benefit — the mandatory minimum coverage every insurance policy must include — is currently $252.27.

Mr DeSilva said: “Someone who works behind the cash register at MarketPlace, they pay $252.27. The CEO of a large company also pays $252.27.”

But that could change. Dr Jennifer Attride-Stirling, CEO of the Bermuda Health Council, an advisor on the plan, said the idea is to increase the coverage offered in the standard health benefit, with the costs staggered across the pay scales.

She added: “Currently everyone pays the same amount but it represents a different burden for people on different salary scales.”

During meetings with international business employers and the Chamber of Commerce, bosses expressed concern about the potential increase in costs.

But Mr DeSilva said they had been reassured that they would be involved in the development process. He added: “Some of us may have to pay a few extra dollars but what is the alternative?

“We know the cost of healthcare is rising at four times the rate of inflation. People are struggling.

“I’m in a position to pay a few extra dollars. What is the humane thing to do?”

The plan will also look at waste within the system.

Mr DeSilva said some poorer patients opt to use the emergency room for minor ailments instead of going to a GP because they cannot afford the cash for the up-front payment.

He added: “I may think I’ve sprained my arm but instead of going to the doctors I go to the ER because that is fully covered by my insurance. The doctor’s visit might have cost the system $150 whereas the hospital cost $450.

“The plan will look very closely at the up-front payment issue with a view to abolishing it for covered services.”

The co-pay element of doctors’ visits could also be reviewed.

Decisions will not be made until after the consultation process.

Resources

Unnecessary tests have also been blamed for contributing to rising costs, with doctors sometimes being pressured by patients for MRIs or CAT scans that are not always necessary.

Dr Attride-Stirling said there were examples across the world of healthcare systems with older populations who managed their resources more efficiently.

She added: “There is enough misuse of resources in the system to cut the fat and provide care to the 10 per cent that are uninsured.

“We can do that with the same funding by making smarter use of resources, health promotion and a more proportional financial burden.”