Dear Sir,

With reference to the article by Jonathan Kent on the Government’s plans to overhaul the healthcare financing system, it is yet another example of big decisions being made without there being a meeting around the table of all the stakeholders.

Just shifting dollars around is not going to stem the tide of rising healthcare costs and, more specifically, healthcare expenditure. The Bermuda Hospitals Board accounts for 46 per cent of healthcare expenditure, and unless that area is addressed appropriately, healthcare expenditure will never be controlled or curtailed.

I suspect that the recent increases in BHB expenditure have been the result of more itemised billing. Several years ago, the Diagnostic Related Group was implemented with the intent to decrease cost. What happened to the DRG, or was it ever implemented and utilised correctly?

In the United States in the mid-1970s, Utilisation Review was implemented by the Federal Government as a method to control cost and ensure appropriate care of in-hospital Medicare patients, and by the mid-1980s private insurers followed suit. In spite of initial grumblings, there was compliance with the process by all involved and it became the new “norm”.

I find it surprising that the UR has not been implemented in Bermuda at the BHB. I do not comprehend the logic and concept of pooling private insurance and government funds. Is this a model that has been engaged in other jurisdictions with some degree of success?

Can the Government, or should the Government, be allowed to have the private insurance industry fund the pool?

If the insurance industry has to increase premiums, that will further increase healthcare cost and further burden the subscriber. If the health industry exits the healthcare market, can the Government afford funding for the whole population?

The UR should have been implemented years ago and it should be implemented now. The private insurer should be allowed to engage the UR process on in-hospital patients as well as outpatient services and government resources should be expected to do the same. Even if by chance there is “pooling”, then the UR process still should be engaged by the insurance industry and government resource entity for each to “monitor” the money. It makes no sense just to have the funds and not ensure it is utilised appropriately.

Utilisation Review is the easiest, simplest process to implement and one can rest assured that used correctly this procedure would result in a significant decline in BHB expenditure and with no compromise in the quality of care the Bermuda population is known to expect.

BURTON BUTTERFIELD

Paget