Bermuda’s health financing is a staggeringly complex arrangement — especially for a comparatively small jurisdiction.“The input we’ve had from our advisers, who have experience of different health systems around the world, is that this is more complicated than what exists in other jurisdictions. In particular, for a population of our size, it’s highly complicated,” said Jennifer Attride-Stirling, CEO of the Bermuda Health Council.As part of our ongoing series on the Island’s rising healthcare costs, The Royal Gazette explores the structure of Bermuda’s financing.The Island’s Standard Hospital Benefit (SHB) package serves as the base of the system — covering much of the population, plus a substantial range of hospital services.The SHB deals with most of the local spending, plus a third of what we spend overseas.Currently, residents pay a $326 monthly premium for the basic SHB package — but a breakdown of who pays for what shows Government picking up a hefty portion of the bill, for seniors in particular.1: Dimensions of health coverage“In order to understand how health insurance coverage is organised on the Island, we can represent it as a cube — an illustration scheme developed by the World Health Organisation,” said Dr Attride-Stirling.“A health system with universal coverage for everybody would fill the whole cube: all of the population, all of the costs, all medically necessary services.“Each country fills the cube in different ways. For Bermuda, at the base of the cube is the Standard Hospital Benefit (SHB), which covers most of the population. It includes Government’s subsidies.“The SHB covers all hospitalisation costs — but out of medically necessary services, it covers about a third.“Government’s Health Insurance Plan (HIP) covers a little bit more of the population and a few more services. FutureCare covers a sliver of the population because it’s designed for seniors, and it’s more generous than HIP.“Then, under Supplemental Benefits, we have the standard medical cover that most employers provide.“There are other systems such as the Canadian, UK and French systems that cover significantly more. This illustration shows how the SHB plays a role in relation to the whole of Bermuda’s coverage.”2 and 3: The Standard Hospital Benefit — and how much Government pays“The breakdown of Standard Health Benefit (SHB) claims by age graphically illustrates how we incur more health costs as we get older,” Dr Attride-Stirling said.In the bar-charts shown, the red portion of the bars covers the long hospital stays, or the Continuing Care Unit costs.“We can see that red proportion growing sharply as the population gets older,” she said.“There’s a spike in the zero to four years category. There are birth costs and neonatal care, which then drops off. It’s around the age 50 to 54 that the costs start to go up.”A comparison of the two charts reveals how “Government subsidies cover a huge amount of the bill,” she added.“You can also see how the subsidies are designed for youth and the aged. It also covers the indigent. When you look at the difference between the two charts, you can really see how Government is taking the hit for those claims, under our current system.“People naturally complain about their premiums being high, but you can imagine what they’d be without the subsidies. It’s easier to understand when you see just how much the Government actually spends.”Useful website: www.bhec.bm.