The gap in healthcare expenditure is growing wider between the rich and the poor, according to a report.

Within the space of three years, families in low-income households were spending twice as much on healthcare, at a fifth of their income.

However, high-income households were spending disproportionately less, with expenditure dropping from almost five percent to three percent of their income.

This is despite Government funding for the health system increasing by 80 percent since 2000.

The Bermuda Health Council unveiled the results of the Bermuda Health System Profile 2009 yesterday, giving an overview of the health system and progress of reform.

The results will form the basis of BHC's policy recommendations to the Ministry of Health. They will also assist health insurance companies, the Bermuda Hospitals Board, physicians and other healthcare providers in care decisions and strategy.

The report states that in 2004 high-income households spent 4.5 percent of income on health expenditure, compared to a spending of 10.3 percent in low-income households.

In 2007, high-income households spent 3.3 percent but those classed on a low-income were paying out 19.9 percent of their income on healthcare.

Since then Government has introduced FutureCare, a low-cost health insurance plan for seniors, but the results have not yet been measured.

The report states: "Evidence of impact is not yet available, but positive impacts may have been offset by the reduction of private options for seniors in 2009."

The Health System Profile Report 2009 also reveals public healthcare costs to taxpayers have risen 82.1 percent since 2000. Private funding has risen by 66.3 percent.

The Island's health system is a mixed private/public model, with providers being paid on a fee-for-service basis. Financing is approximately 70 percent private and 30 percent public sector.

In 2008 total health expenditure was $487.3 million, 16 percent of the national budget. Public (Government) funding was $154 million and private expenditure $333.3 million.

Of private funding, out-of-pocket payments by patients are estimated at 14.7 percent of expenditure, or $71.6 million. This includes insurance co-payments and full cash payments for services.

Per capita healthcare spending in Bermuda was $7,635 in 2008, an increase of 45.2 percent on 2003.

Among the report's other findings, the percentage of the population who are overweight or obese has increased by seven percent, from 57 percent in 1999 to 64 percent in 2006.

The report states: "Most leading causes of death in Bermuda are related to chronic, non-communicable conditions caused by lifestyle factors such as inactivity and poor diet."

The Ministry of Health has identified obesity as "the number one health concern for Bermuda".

Also of concern is diabetes. The disease affects 14 percent of the population 9,000 people, one of the highest rates in the world.

The report states: 'It is estimated that only two-thirds of type two diabetics have been diagnosed."

Diseases of the circulatory system however, have been the leading cause of death for the past five years. This reached 47 percent in 2008 (195 people), up from 31 percent in 2003.

The next cause is cancer, at 25 percent (104 people).

The report says HIV infections have increased from eight in 2002 to 22 in 2008. However, since 2006 the Health Department has implemented an HIV/AIDS strategy.

It also notes the proportion of the population under-15 is declining while seniors are increasing.

In 2009, life expectancy at birth increased to 79.4 years, from 77.9 years in 2000.

The previous Bermuda Health System Profile in 2005 identified Quality Assurance in Personal and Population-based Health Services as needing "urgent attention".

The 2009 report says "improved performance measures and reporting processes" were actioned by Government between 2006-8.

Other recommendations in 2005 were better communication, monitoring, and technical assistance to the non-government sector.

Among the healthcare reforms flagged by the 2009 report are a national health promotion strategy, new hospital billing system, hospitalist programme, urgent care centre and a Government-run health insurance plan for seniors (FutureCare).

In 2006, the Department of Health introduced 'Well Bermuda: A National Health Promotion Strategy' which was updated in 2008. Eighteen goals identified national priorities, objectives and action areas.

In 2007 five action plans were rolled out on obesity, diabetes, seniors, disability and parenting.

In 2009 Health Insurance Section staff were transferred from the Finance Ministry to the Health Ministry and reorganised as the Health Insurance Department. The information technology infrastructure is also to be upgraded.

Also last year, KEMH implemented a new billing system based on Diagnostic Related Groups, replacing the previous 'per day' billing. It aims to be cost-neutral to the health system but shift costs from the Government to the private sector.

"Monitoring mechanisms are in place between the BHB and payers to ascertain the impact on all stakeholders," the report states.

The 2009 Health System Profile is the first report since the creation of the BHC in 2006.

Dr. Jennifer Attride-Stirling, BHC CEO, said: "This report provides vital information that is essential to develop evidence-based policy and recommendations to the Ministry of Health.

"It enables us to effectively and efficiently monitor the performance of our health system in a number of areas, to ensure the system continues to deliver high-quality services, while remaining sustainable."

Linda Merritt, BHC chairman, said: "This report will play a vital role in providing the Bermuda Health Council with current data on which to act and make recommendations on a number of key reform initiatives."

The report uses Pan American Health Organisation (PAHO) methodology to measure the local health system against international standards.

To view the findings to go: www.bhec.bm/resources/health_stats.html-

FACTFILE:

Population estimate of Bermuda 2009: 64,000.

Total health expenditure: $487.3 million 2008, or $7,635 per capita. $154 million of this was public funding and $333 million was private financing (private health insurance $259.8 million, out-of-pocket payments $71.6 million).

In 2009, 83.6 percent of the population (53,837) had health insurance coverage. However, the other 16.4 percent are thought to be schoolchildren, expat consultants and their dependents, and the uninsured.

Life expectancy at birth: 79 in 2009, 78 in 2000.

Women outlive men by 5.3 years. In 2009 they had an average life expectancy of 82 years, against 77 years for men.

In 2006, 64 percent of Bermuda's population was classed as overweight or obese.

Currently 14 percent of the population have diabetes (9,000 people).

In 2007 Bermuda recorded 417 deaths. Diseases of the circulatory system are the biggest killer, at 47 percent, up from 31 percent in 2003.

The infant mortality per 1,000 was 4.9 in 2008.

HIV infections have increased from eight in 2002 to 22 in 2008 (13 men, nine women).

In 2008 there were 41 general or family medicine physicians (six per 10,000 people).

KEMH has 360 beds, a ratio of 6 beds per 1,000 people. In 2008 the hospital employed 45 physicians, 391 nurses and 94 health professionals.

MWI has 95 beds one bed per 1,000 people. It employed nine physicians, 87 nurses and 15 health professionals.

There are 127 registered doctors on the Island, 31 dentists, 30 pharmacists and 522 nurses.