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Kidney dialysis cost to drop

A comparison of haemodialysis prices in international markets (Image by the Bermuda Health Council/Overseas Care report)

Haemodialysis prices will drop by $353 per session on June 1, reducing yearly spending by an average of $55,000.

It comes as the Ministry of Health seeks to ensure transparency and consistency in healthcare costs by basing more pricing on the relative value unit methodology.

“The new dialysis fee is progressing towards RVU’s with a Bermuda conversion factor and ensures pricing that more accurately reflects the cost of providing a service,” a spokeswoman said.

“This has resulted in a proposed change in haemodialysis fee from $1,317 per session to $964 per session, reducing the spend by an average $55,068 per year.”

The spokeswoman said the Bermuda Health Council started using the RVU method in 2013 to price diagnostic imaging services in the community, and that it is now being applied to more services.

She added: “The ministry is seeking to have more healthcare pricing based on the RVU methodology to ensure transparency and consistent pricing.”

According to the Health Council’s Overseas Care: A Synopsis of Trends for the Islands of Bermuda report, 2016 haemodialysis fees for three sessions in Bermuda were more than double that of the United States and more than four-and-a-half times that of the United Kingdom.

A spokeswoman for the Health Council told The Royal Gazette: “In the US, providers receive an average of $230 per session for haemodialysis, peritoneal dialysis, and in-centre in Bermuda the per-session cost of haemodialysis is $1,317. The average person requires about three sessions of haemodialysis weekly.”

While she calculated that supply costs should total $126.50 per session, this does not include costs based on the supplier used, cost of the drugs, cost of shipping, duty, relevant surcharges, and costs associated with care delivery including staffing and overheads for location. She also noted that dialysis pricing on the island was historical, with no major review conducted until recently.

A Bermuda Hospitals Board spokeswoman told this newspaper that the hospital’s dialysis fees also cover the purchase, upgrading and maintenance of equipment, as well as staffing and on-call coverage costs.

“The fee also covers the cost of hospital space and maintenance, utilities, housekeeping, etc.

“Additionally, these fees help cover other services and costs associated with keeping the community’s hospital running around the clock, including the cost of providing services to those people who are uninsured and cannot pay their bills, and whom Government cannot afford to pay for through subsidy.”

She stressed that any surplus was “entirely reinvested in care” and said this is increasingly being used to “cover the growing shortfall from bills charged to Government for vulnerable populations covered by subsidy (seniors, indigent populations and youth), as well as subsidising other services for which fees are set well below the true cost, but are needed by the community”.

“The additional cuts to the Government subsidy and fee schedule BHB faces this fiscal year will only intensify the pressure.” She added that BHB does not set or add new fees and that it cannot charge co-pays to supplement the fees covered by insurance and subsidy.

In providing an update on the Bermuda Health Strategy and Action Plan to the Association of Bermuda International Companies, health minister Jeanne Atherden said strides had been made to reorganise payment systems to focus on value and outcomes, improve benefit design to reduce unnecessary trips to hospital, and to develop a healthcare workforce plan to address the needs of 21st -century Bermuda.

For the “first time on record”, health spending went down by 1.1 per cent in 2015, she said. “We finally bent the cost-curve — and we’re the first country to do so, compared to the OECD.”

However, she added that spending $11,102 per capita on health is still too much and there is “some way to go to achieve sustainability”.

“Currently, there are approximately 170 patients on dialysis at the cost of $200,000 a year, each — this $34 million expenditure has been targeted in our reforms”.

For example, coverage is to be increased for kidney transplants, which can cost $130,000, thus helping more patients to come off dialysis.

Such measures, combined with a drop in diagnostic imaging fees and the cost of long-stay hospital beds, are expected to deliver more than $20 million in savings in one year.

This would represent “the single, largest reduction in health costs our system has ever seen”, Ms Atherden said.

Other ongoing programmes include a review of the Mental Health Act, with more details on caregivers given on the government website — while the personal home care benefit has been taken up by one private insurer, with others hoped to follow suit.

With a “crisis” in bed capacity affecting the hospital, the private sector is now being courted for long-term care investment, from facilities to workforce.

And while the minister said there had been “headway” in the regulation of healthcare professionals, legislation overseeing healthcare businesses had yet to be approved.

“However, I remain committed to introducing the necessary regulatory controls, and hopeful that the Bermuda Health Council Amendment Act will ultimately be passed,” Ms Atherden said.