The latest grim forecast for the Island’s health costs has underlined the need for a unified effort, insurers BF&M have warned.The Bermuda Health Council has projected that locals will spend $1.7 billion on their healthcare in 2021.Said BF&M president and CEO John Wight in response: “We’re all in this together. Now, more than ever, we have got to work together.“When I saw that possible figure, my first reaction was that with the collective efforts of the Ministry of Health, the Bermuda Hospitals Board, the Bermuda Health Council and local insurers, we can pull together to reduce it. That number is based on assuming the rate of inflation will mirror that of the last few years but we all recognise that would be unsustainable for Bermuda.”The Island spends the equivalent of 11.8 percent of its domestic gross product on healthcare according to the 2012 National Health Accounts Report.By comparison, the US spent nearly 18 percent at the close of the 2010/11 fiscal year; the UK stood at 9.6 percent, and the average for OECD states was 9.5 percent.Mr Wight said that BF&M had been tackling Bermuda’s costs by working with policy holders and finding options to cut down on the use of overseas care.“For many groups wanting to reduce their healthcare premiums, one way is to reduce the number of facilities overseas that people go to. They don’t have the same cachet as Johns Hopkins, but they’re good providers,” he said.Rising health premiums appeared to be “a given” for insurers, Mr Wight added. The question was whether they would rise ahead of inflation.“It’s hard to imagine, with our ageing population, that healthcare costs will not increase year after year,” he said.Mr Wight said BF&M does not anticipate “a great wave of claims” when new regulations cutting upfront payments come into effect on Wednesday.However, he added: “Until it materialises, we can’t say definitely.”Asked for the top culprits in local costs, a Ministry of Health spokeswoman responded: “The main reasons why costs are high here are related to the reasons why they are high in other countries: the types of health services used by the population, the amount of services they use, and the price of those services.”She added that high-tech medical procedures are costly to run and “if they are demanded and used liberally this drives up costs overall”.A doctor’s visit, for example, is less costly to the healthcare system than a visit to the Emergency Room.“Poor health and unhealthy lifestyles can also drive up costs. Obesity leads to chronic conditions, drunk driving leads to road traffic fatalities, and so on. And if you have a condition like diabetes or hypertension, controlling it is less costly than treating its consequences.”Meanwhile, Shadow Health Minister Michael Dunkley questioned why Government seemed to downplay the role of hospital spending.“The One Bermuda Alliance has had a summary review of the 2012 National Health Accounts, and one of the points that jumped out at us immediately was the significant role that [King Edward VII Memorial Hospital] has played in driving up total healthcare expenditure over the last two years from 2009 to 2011,” he stated.The report shows increased hospital spending accounting for “approximately two-thirds of the increase in total healthcare expenditure in the last two years”, Sen Dunkley added.“While the Minister continues to talk about the unsustainable increases in healthcare expenditure and the impact on our community, any increase in hospital costs is barely mentioned in the National Health Plan, even though these are by far the largest driver of health costs overall.”Bermuda Employers’ Council president Keith Jensen pointed to the drop in international business as a contributor to health costs in Bermuda.“A lot of younger non-Bermudians have left, which means the costs for the rest of us are going to increase,” he said.With more people out of work “more people are going to the Emergency Room at the hospital instead of going to their doctors, which is another costly problem”, he added.An Immigration policy that was “more welcoming to international business” would help to stimulate the Island’s economy and ease the burden on workers and employers, Mr Jensen said.The BEC head said cost-controlling measures like BF&M’s along with more cost-effective health plans, had helped considerably in reining in costs overall.“Without these efforts by insurers and suppliers of services, the costs that the Minister has been talking about would have been considerably higher,” he stated.Useful website: www.bhec.bm.lSee Editorial on Page 4