Matters in Healthcare: Should I get a mammogram every year?

Question: My mother went to see her doctor shortly before her regular prescription ran out, but the prescription was not refilled during her visit. Instead, she had to call for her prescription after the visit and they charged her $15 for faxing the prescription to the pharmacy. Is that the best way to do this, especially when she is a senior and on a fixed income? 

Answer: As with all medical visits and issues, the best way to handle the situation is to ensure there is an open dialogue and communication between the health professional and the patient.  

Feedback to the office regarding an overlooked prescription refill and the perceived injustice of the additional charge is an important step in communicating dissatisfaction with an office’s policy.  

Asking to speak to the physician or to have them call the patient to discuss the situation is an entirely appropriate request for your mother to make. It may also quickly clear up an oversight or miscommunication. 

Generally speaking, while physicians don’t charge for writing a prescription during an office visit, some physicians do charge for phoned-in prescriptions. This was introduced to acknowledge the cost of providing a service in the patient’s absence, which includes reviewing the patient’s chart and ensuring the proper prescription is written.

Going forward, to try and eliminate the need for a faxed prescription, consider a call before your mother’s appointment or a quick conversation with the physician outside of the normal visit to assure the office understand the need and expectation for a prescription refill at the time of the visit. Direct and open communication before, during and after office visits are important to assure your mother’s needs are being met.

If it is a case where the prescription cannot be filled until the other one is complete, then the doctor’s office can fax the prescription to a pharmacy. The Standards of Practice for Medical Practitioners require that any fees be discussed with clients before the charges are incurred. 

Again, hopefully this will not have to happen on a regular basis and with added communication with the physician another solution may occur.

Question: My health insurance premium went up this year, but I heard Government premiums went down. How is that explained?

Answer: Health insurance premiums in Bermuda are made up of two components: the Standard Hospital Benefit (SHB) and supplemental benefits. SHB is the minimum benefit that must be included by law in every health insurance policy sold in Bermuda. It covers largely the cost of local hospitalization. 

The SHB premium is set by Government annually based on the full insured population. Due to Government’s financial position, this year there were a number of changes in the SHB benefits which resulted in a decrease in the price of the SHB portion of all health insurance policies. 

Supplemental benefits, on the other hand, are not set by Government, so the coverage and premium varies depending on the policy, the individual, the group and past costs. All insurers (whether public or private) set premiums annually depending on the risk associated with these factors. This means the premiums will vary based on a range of circumstances. 

In addition, this year some of the changes to the SHB impacted the supplemental benefits, shifting the coverage from SHB to supplemental. Combined, these factors resulted in supplemental premiums varying, which is why your premium may have gone up overall. 

The SHB changes are explained more fully in a one-page leaflet called “Standard Hospital Benefit Changes for 2014/15 Need to Know”, at www.bhec.bm/pamphlets. 

Question: I’m a 46-year-old woman with no family history of breast cancer. My GP told me that given my 5 clear mammograms, it would be ok to screen every two years. But I was always told women needed to have annual mammograms. Who do I believe?

Answer: This issue is starting to come up more and more, so you’re in good company. The medical profession is led by clinical guidelines and knowledge of a patient’s history to make screening decisions. Unfortunately, international clinical guidelines on mammography do vary. Some guidelines recommend annual screening for women over 40, and this is what we have been familiar with in Bermuda. However, other guidelines from highly reputable medical bodies in the US and internationally recommend mammograms every two or even three years, depending on the age and family history of the woman. The best decision is the one you make together with your GP. There isn’t a one-size-fits-all and your personal doctor will help to put the advice into context and help you make a decision that is the best fit for you. 

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 your queries and look for our response in the Bermuda Sun on the last Friday of every month and on www.bermudasun.bm