Matters in Healthcare: Overseas testing and containing healthcare costs

Question: I was experiencing extreme pain in my stomach and went to the hospital. They ran a number of tests, but couldn’t find what was wrong. Still experiencing pain, I was referred overseas where the doctor indicated that I had to repeat all of the tests completed in Bermuda! It seemed over-the-top, but they were able to diagnose me, which the doctors here hadn’t been able to, so it seems worth it. If we receive better care overseas, why should any of us stay on the island?

Answer: This is a great point, and one that is often heard. 

Decisions to test or re-test are based on a host of factors; for example, there are some conditions that require repeat testing to monitor trends, so there are times when re-testing overseas would be within the standard of care regime. 

But, in addition, your question highlights that patients naturally have high expectations from medical providers, and that, like patients everywhere, there isn’t always a full appreciation of the nature of medical care. 

Although we’d like medicine to be easy and mechanical, in fact, often it is rather more complex; diagnosing and treating (at times little-known) conditions is not easily done. 

Add to this that Bermuda is, in global terms, just a tiny village in the middle of the ocean and we have an explosive situation. There is no tiny village anywhere in the world where local health providers are experts in everything or where every test and treatment is available. 

Large countries have the benefit of specialized centres of excellence and teaching hospitals to handle complex cases that surrounding community hospitals and doctors cannot test or treat. 

In Bermuda’s case, we’re lucky to be connected to excellent care overseas, but this should not be mistaken for an indication that the care here is sub-optimal or inadequate. It’s just like it would be in most tiny villages — in fact, in some respects it’s much better. Objective and independent analyses of Bermuda’s health outcomes show that we do very well in a lot of things.  

There’s room to improve, naturally. But context is important. Luckily, instances of care gone wrong are infinitely fewer than those when care goes right. As with everything, it’s key to be mindful of local limitations and ensure our healthcare professionals work in tandem with specialists overseas for care and also to reduce unnecessary duplication of tests, which can lead to escalating costs. 

We have room to improve in this area to avoid the repetition of tests and misdiagnoses that you went through, but there is work underway with the right medical leaders to get better at this.

Health costs and insurance premiums are sky rocketing. The Health Council is supposed to control health costs, yet they keep going up. Aren’t you doing anything about it?

Response: The Health Council recommends the premium for Bermuda’s minimum insurance package, and the fees of any new services under it. 

But this is not enough to control health costs. About 60 cents of every dollar spent on healthcare is unregulated and outside this package, so there are limits to the Council’s reach. 

In addition, of the 40 cents that are regulated, the Health Council has no authority over the majority. For example, contrary to popular belief, BHeC does not currently set the hospital’s fees. 

That process is handled between the Bermuda Hospitals Board (BHB) and the Ministry directly and the Council at present has minimal input or involvement. 

Nevertheless, health costs and insurance premiums are a major concern for the Health Council, and we are active in the areas where we do have authority — for example, we introduced a home medical services benefit so that some patients can be seen in more appropriate and cost-effective settings. 

There is a long way to go and there is no magic bullet. 

But what is certain is that collaboration across sectors is needed to make sure services are used appropriately (more tests don’t equal better care), fees are fair, care is coordinated, and people have healthier lifestyles (time to put the chips away and get off the couch, folks). Enabling this collaboration is where the Council seeks to make a difference. 

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