Nearly half of the health care providers in Bermuda demand full payment for medical care at the time of delivering the service, said Bermuda Health Council.

But evidence suggests these "upfront payments" can add to family cashflow problems and also prevent people from getting proper health care when symptoms of illness first arrive. As a result, the council and Ministry of Health have created new guidelines for upfront payments and say these could make health care more accessible for families on the Island. The guidelines seek to minimise the amount of health care providers who ask customers for full payment of the bill before receiving the services.

A telephone survey conducted by the BHeC in April 2009, showed 47 percent of providers in Bermuda either sometimes or always ask for payment at the time of delivering services. Jennifer Attride-Stirling, Chief Executive Officer of the Council, says: "Health care should be accessible and affordable to all and the requirement to pay significant sums at the time of receiving services can prevent some people from seeking care in a timely manner. The Guidelines are intended to promote a level playing field and an environment of fairness and trust among providers, insurers and patients, by establishing a shared framework of what is possible and what is fair in paying for health care."

The nine guidelines developed by the Upfront Payments Committee (UPC) aim to get insurers to pay providers withing 30 days of service. Therefore service providers will be less likely to charge patients up front.

It also encourages providers to use standard forms which give insurers all the information they need to promptly pay for a claim.

Among other things, it encourages health care providers to warn customers about the costs of services before they are delivered. Minister of Health Roban said he was pleased with the hard work done by the UPC and added: "We look forward to these new guidelines helping to lessen the financial burden on families when accessing health care.

"We are grateful to the Upfront Payments Committee for developing the guidelines, which represent a tangible step in self-regulation within the health care sector. We appreciate the work of both health care providers and insurers in making the changes necessary to alleviate the impact of this practice on patients," he said.For more information on the upfront payment guidelines or to see the guidelines in full visit www.bhec.bm.