Bermuda Hospitals Board is a “convenient target as the culprit for healthcare inflation” but this criticism is unwarranted, according to the chief of staff.

Michael Weitekamp said BHB accounted for only 45 per cent of the Island’s $700 million spent, with the rest from community services and providers, and nearly $100m in overseas care.

“Those percentages have not changed significantly over the past 10 years,” he said. “This indicates that all health care costs are going up, not just BHB.”

Dr Weitekamp also criticised the SAGE Commission report for not directly addressing “Bermuda’s greatest asset — the health and vitality of her people”.

“Without a healthy, holistically well and engaged citizenry, nothing can be achieved,” he said.

“Without a robust, balanced, modernised and affordable healthcare system, Bermuda will be incapable of the transformational changes required to advance on the global stage.

“It is hard to see a way out of the woods when you take into consideration the level of national debt and annual deficits.

“There is also a declining population and aging demographic, under-funded pensions and limited planning for alternative care settings, and this is not a problem unique to Bermuda.”

Dr Weitekamp spoke out about health and the hospital’s new acute care wing at a Hamilton Rotary Club meeting yesterday.

He said there was “little to be proud of in the health outcomes” even though Bermuda has one of the highest healthcare costs per capita at $10,562.

“Bermuda has one of the highest global rates in obesity, diabetes, dialysis and limb amputation, as well as a high incidence of road traffic accident deaths and life-altering injuries,” he added.

“As important as access to high-quality and affordable acute care is for our health, safety and peace of mind, acute medical services and even chronic services in our GP or specialist office contribute less than 20 percent of the ‘wellness’ of a country.

“The so-called ‘social determinants’ of health are so much more potent — education and socio-economic security (poor health mediated by stress), personal behaviours/choices, the environment, and genetics (predisposition, not destiny).”

Dr Weitekamp dedicated much of his speech to focusing on why health care is so expensive.

He said a heavily government-subsidised system fuelled innovation, but also “perverse incentives” and waste, and that “socioeconomic, environmental and behavioural” determinants of health came second to acute intervention.

“An ounce of prevention is worth even more than a pound of cure,” he said.

Insurance and care processes were described as “fragmented and stunningly inefficient”.

“Bermuda has 60,000 population and seven different insurers … there is huge actuarial risk and administrative inefficiency in such small numbers and this lowers attachment point for reinsurance which subsequently increases the cost,” Dr Weitekamp said.

“A relatively small percentage of the population accounts for majority of expense. To lower costs and improve outcomes for this population, one needs a holistic approach that incorporates strong public health infrastructure and outreach, social services and a level of team-based coordination and reliable electronic records that is missing in Bermuda.”

Dr Weitekamp also said patients and providers were unaware of the actual costs of services, such as using the emergency room — because there is no co-pay they believe it is free.

“You’ll pay through higher premiums next year,” he warned.

A fear of litigation and “being second guessed” drives excessive testing, Dr Weitekamp said, while prices are higher than other developed countries “due to many factors, but mostly input costs”.

He also attributed rising health costs to inefficient prevailing payment models and a greater intensity of high-tech services.

But there are ways to “slow the cost curve and improve quality”, he said.

These methods include more data sharing and collaboration between public health and healthcare providers, and increased focus on preventing avoidable conditions.

“Right now, about 170 Bermudians are on dialysis — just over ten years ago there were only 60 Bermudians on dialysis. This increase has taken place over a time of declining population numbers,” Dr Weitekamp said.

“It is a disease that can be prevented in many instances, for example by proper management of hypertension or diabetes.

“Being on dialysis has a big impact on the well-being of an individual and a family, but we are all impacted too through the premiums we pay.

“The cost of dialysis is about $200,000 per patient, per year. So the cost to us all has gone up from about $12m — if there had been still about 60 patients today — to $34m.

“And that doesn’t include medication, consultations and the other complications an unwell patient might have.”

He called on providers to minimise unwarranted testing, and for transparent pricing and enhanced coordination with overseas providers.

Dr Weitekamp also urged people to be treated in Bermuda, when possible.

“It benefits both you and the healthcare system if you stay on-Island. With the new acute care wing, with its state-of-the-art operating suites and inpatient rooms, you can get more of the care you need at home.

“We have a new CT and MRI and the latest radiology equipment in the new acute care wing.

“Health literacy, personal accountability and behavioural changes — your health is the most valuable resource you will ever own and you had better cherish and nurture that resource appropriately.”