Stark new figures reveal how chronically sick Bermudians fare worse in comparison with British diabetes patients.

However, the Bermuda Wellness Foundation sees hope through tweaks to the island’s healthcare model. Two proposals emerging from a “groundbreaking” report include ditching the outdated fee-for-service billing model, and adopting an island-wide electronic medical record system.

Evidence in the QResearch study, commissioned by local residents and health IT specialists Sean and Jenny Riddell, was “shocking”, according to Ms Riddell.

“We’ve known that there’s a problem, but this is evidence showing the extent of the difference between how diabetes is managed in Bermuda and elsewhere,” she said.

Findings in the October 2017 report include:

• Bermuda’s diabetics are on average eight years younger than in the UK, at 57 versus 65 years

• Local patients confront the most serious complications at an earlier age

• Kidney failure strikes Bermudian diabetics at a markedly higher rate

• Fewer Bermudian patients avail themselves of simple medical tests to avert serious complications such as kidney disease

The Riddells declared their interests to the Gazette: in 1989 the couple helped develop extensive electronic medical records in the UK.

They have since retired, and commissioned the local report free of charge for the Bermuda Wellness Foundation.

Although familiar with the island, the couple were “amazed that it was probably the most expensive place in the world to do healthcare”, Mr Riddell said.

“We discovered a shocking health outcome for the amount of money spent.”

The study used 2016 data, stripped of personal details, to compare British records with Bermudian patient data mined from insurance claims.

Calling diabetes “a national crisis”, the Riddells said the report “clearly shows Bermudian diabetics are not receiving the effective preventive care they should”.

Bermudians are considerably ahead of the UK when it comes to kidney failure: almost 10 per cent of locals over 75 show signs of renal failure.

In addition, the cost of medication may deter Bermudian patients from obtaining treatment: the island’s patients lag significantly behind Britain in the use of prescribed insulin and oral hypoglycaemic drugs.

Bermudian patients were eight times more likely to have an MRI or CT scan — but still trail behind the UK for much cheaper blood tests to spot early stage kidney disease.

Mr Riddell noted: “What we’re finding is the fee-for-service model does not reward doctors for preventive care and education.

“It rewards them for more tests than necessary. It baffled us at first, but we have concluded that fee-for-service is a massive obstacle.”

Bermuda needs a paradigm shift to a “fee-for-value” approach, the couple said: switching to a fee-for-value model based on health results and quality indicators.

Mr Riddell added: “We also feel that diabetics should not have copay for diabetic primary care medication.”

Insurers would likely embrace the shift, Ms Riddell said, predicting that “the biggest resistance will come from doctors ... doctors don’t like to be guided”.

Acknowledging that it was “early days” in effecting change, Ms Riddell said they had shared their pro bono report with David Burt, the Premier, as well as the Ministry of Health.

In addition, pooling the island’s patient records in an easy to access electronic system would enable better monitoring — and risk assessment tools to identify the patients most at risk, before they get sicker.

Michael Richmond, chief of staff for Bermuda Hospitals Board, said that BHB supported adopting electronic health records.

Dr Richmond said the benefits ranged from “improving the quality and co-ordination of care for patients, to improving available data on the health of Bermuda”.

“Having an accurate understanding of who has diabetes, who might be pre-diabetic, and who also might be at risk will help us prevent and manage diabetes better with more focused care,” he said.

Tackling chronic disease in Bermuda is challenged by the fact that “our knowledge of the population is a bit like an iceberg”.

“We only know what we can see,” Dr Richmond said.

“What is below the water is often not managed, or not managed well. This raises the increased risk of severe and sometimes life-limiting complications.”

The benefits of electronic health records “also extend to patient experience and outcomes as it will help care to be co-ordinated across the system, reducing duplication and delays”.

However, changing the system could be a tall order.

Dr Richmond conceded it was “an expensive and complex project that will require involvement and support across the healthcare system to implement successfully”.

• To read the report in full and an accompanying statement from Bermuda Wellness Foundation, click on the PDFs under “Related Media”