Trimming the Island’s runaway spending on overseas healthcare doesn’t necessarily mean searching for cheaper hospitals abroad, a US medical expert warned.Residents’ spending on treatment outside Bermuda neared the $100 million mark last year — and the figure continues to rise.Johns Hopkins Medicine International CEO Steven Thompson said the Island’s best bet for containing costs was to develop local primary care and diagnostic services, but to keep travelling for certain complex procedures.His remarks came as the Bermuda Health Council gave further details into the reasons behind the ever-rising costs of healthcare.“It’s a problem all over the world — nobody seems to be able to afford the healthcare they want, in any country,” Mr Thompson said, noting that, as a percentage of its gross domestic product, the US is well ahead of Bermuda when it comes to healthcare spending.Overseas care added up to $96 million, or 14 percent of the Island’s total expenditure last year, causing local insurers to shop around for less costly options.Asked if seeking bargain healthcare abroad was the best option for cutting overseas costs, Mr Thompson said: “I don’t think that’s a solution that would be acceptable to anybody.“There would be uproar from the citizens of Bermuda if people were just being sent off to the cheapest places for treatment.”Mr Thompson, who oversees all of Johns Hopkins Medicine’s international activities, said he was accustomed to hearing people assume the facility was costly.Warning against viewing healthcare from a “retail model”, he added: “Payers tend to look quite narrowly at costs as opposed to outcome, and the long-term benefit.”The top three reasons for locals to visit Johns Hopkins are treatment for heart disease, neurological reasons or neurosurgery and cancer treatment.But overseas treatment options needed to be evaluated in terms of outcomes — or viewed “longitudinally rather than episodically”, he said.“There’s the issue of medical quality, as in correct diagnoses, moving onto what’s the most appropriate treatment plan, or, in some cases, no treatment — as opposed to the retail model, where, if I’m buying something simple like an orange, I look at what’s less expensive in this place or that place.”Asked how Bermuda could best cut down on the overseas healthcare spending, Mr Thompson said the Island would benefit best from improved primary care and better means of spotting and preventing illness.“The idea is to reduce the need to consume healthcare, to stay healthy, to identify risk factors and symptoms before they progress to something serious.“It’s probably something attainable and tenable for Bermuda to develop services that would meet those needs, given its size. People will still need to travel for some high end services.”Large facilities like Johns Hopkins were able to deliver good quality for elaborate procedures, in part by the high volume of traffic served by its physicians, he said.“Part of the notion of quality applies to someone who does a lot of the same procedure. Bermuda’s population is smaller, so that is often not possible.”Nevertheless, the 2014 opening of King Edward VII Memorial new facility should bring down overseas costs and the ability to share images and data with physicians overseas would also whittle away at expense, Mr Thompson added.“The investment that the Bermuda Hospitals Board is making in the hospital itself will allow for more efficient and better care. For example, it’s easier for a new facility to maintain low infection rates. There will be many benefits.”Accounts made public by the Bermuda Health Council (BHeC) show the Island’s private spending on healthcare abroad rose 129 percent from the fiscal years 2005 to 2011 — soaring from $42.2 million to $96.6 million.But exactly what residents were spending it on isn’t fully understood, BHeC CEO Jennifer Attride-Stirling said.“Most of the overseas care increase is likely due to hospitalisation costs but the data we collect currently doesn’t allow us to capture what types of overseas care make up these expenditure figures — the current data lacks such granularity,” she told The Royal Gazette.What the latest National Health Accounts Report does show is increasing use plus cost inflation in hospitals at “jurisdictions where such services are sought”.The BHeC’s Actuarial Report for 2009 showed Standard Hospital Benefit (SHB) spending overseas “increased significantly due to increased use of services, and increased average unit cost”, Dr Attride-Stirling noted.“However, the Actuarial Report does not present the whole picture on overseas care, because non-SHB costs are excluded from the Actuarial Report, which is produced to set the premium rate for the SHB.”Residents also continue to pay more at home as well, in part because local fees hikes are helping to pay for the Island’s new hospital.BHB revenue climbed from $158 million for the fiscal year 2005 to $294 million in 2011 — about 86 percent.According to a BHB spokeswoman, there was a “widespread increase in service use”, on top of the approved fee increases.Asked about the year 2009/10, which showed a sharp jump in hospitals’ revenue from $233.7 million to $272.4 million, the spokeswoman said the $40 million was also due in part to a change in how the BHB charged.“The move from a per diem to a diagnosis-related charge went live in this year, and did result in an increase in revenues on the four medical surgical wards as well as maternity,” the spokeswoman said.The BHB is reviewing its fees in tandem with Government and insurers, she added, and memoranda of Understanding are starting to limit exposure and bring “some control over healthcare costs”, she added.“More accurate coding in Emergency resulted in an increase in revenue, and patient numbers increased in Dialysis, further driving up costs.“Sixteen new beds that came online in the Continuing Care Unit were filled, as demand for places continued to increase. Additionally, there was much higher utilisation of the eight-slice CT scanner.“Significantly more patients were covered by the Hospitalist Programme in this fiscal year — a service that was introduced in the previous fiscal year to improve the standard and consistency of clinical care, and move in line with international hospital standards.“Previously, GPs would have charged for a visit, rather than a hospitalist.“As hospitalists are board-certified internists, they do charge a higher fee, but there are no prior figures about the total amount GPs charged collectively for visiting their patients in hospital and providing phone consultations to make an exact comparison on the impact to the health system.”Useful websites: www.hopkinsmedicine.org, www.bermudahospitals.bm.