Higher income individuals could end up paying more for health insurance than their poorer colleagues in 2013.

In the recently released Bermuda Health Council's discussion paper on reforms to the health insurance industry it said they planned to "consider mechanisms to make premiums be set based on ability to pay".

The United Bermuda Party said yesterday the statements in the paper raised more questions than answers, adding it appeared the Government was looking to implement a more socialised approach to health care.

Last month Jennifer Attride-Stirling, Chief Executive Officer of the BHeC, told The Royal Gazette the discussion paper raised issues on protecting the public as well as promoting equity and cost efficiency within the industry. Suggestions included creating a more "robust" Standard Hospital Benefit package and requiring all private insurers to provide the same basic package at the same price to everyone, regardless of age or pre-existing condition.

Another policy objective said tying premiums to income "provides for cross-subsidy in health care financing between high and low income individuals to ensure affordability of coverage for broad basic package".

The BHeC stated that poor households spend 20 percent of their income on health care, compared to the three percent wealthy households spend.

"Proportionality helps spread the financing risk as health care expenditure rises relative to incomes," the paper stated.

It added that the BHeC will develop proposals to "operationalise this policy instrument" over the coming year. The BHeC stated the implementation of the proposal could take place in April 2013.

Opposition spokeswoman for Health Louise Jackson said the proposal created more questions than answers. "Does it mean different workers paying different amounts for exactly the same service?" she asked.

"So would professionals pay more than restaurant workers for the same health services? We have seen a strange version of this with the Government's roll-out of FutureCare, where the second tranche of seniors enrolled in the programme pay twice as much for the same coverage provided to the first group of seniors who enrolled in the programme?

"Cross-subsidisation is not a new idea, but it does suggest the Health Council is trying to open doors to a more socialised approach to the provision of heath care."

Mrs. Jackson said that cross-subsidisation was the foundation of nationalised health care systems such as the one in place in the UK. "But of course in the United Kingdom they base it on income tax," she said. "I do recall Health Minister Walter Roban, not so long ago, promising a revolution in health care. Perhaps this is what he was alluding to.

"But I don't know — nobody really knows — because the Minister's statement was big on words but very thin on details and meaning. Perhaps this item — cross-subsidisation — is the thin edge of a wedge the Government has not yet raised with the public.

"From my vantage point, the ball is in the Health Council's court — and ultimately the Government's court — to explain the intentions behind this idea. There must be some sort of vision behind it for it to get included as a key discussion point in the Council's consultation paper."

A Government spokesman said last night: "The Minister noted that if the Opposition Spokesperson has a view, she should submit it in writing to the Health Council by the deadline on the 30th August. The Health Council is leading the process of reviewing comment on their proposals and when they conclude that, they will consult further, clarify if necessary and then make recommendations to the Minister for Cabinet's consideration."

Members of the public are being asked to read the discussion paper and provide feedback on the proposed reforms by August 30 to dkcommissiong@bhec.bm.

The report is available at http://www.bhec.bm/resources/reports_pub.html