A pharmacy head’s insistence that the Bermuda Health Council’s financing numbers fail to add up got a rebuttal from its chief executive on how the regulator’s role has evolved, as well as complex changes in the island’s healthcare financing.

Ricky Brathwaite responded to criticism from Denis Pitcher, who with his spouse owns My Pharmacy LLC.

Mr Pitcher accused the council of falling behind on financial reporting and challenged Dr Brathwaite’s assertion that “total allocations managed by the health council have not changed since 2021”, when its administrative fee rose from $1 to $3.06 per insured person.

Mr Pitcher said the council’s own website ran counter to the CEO’s claim.

He said the document, Standard Premium Rates for fiscal years 2016 to present, showed that “the figure increased again in 2023, to $5.36 per insured person per month, a fivefold increase from 2016”.

He said the rise did not appear to have been legislated, meaning the council’s “draw from the premium has risen twice since 2021: first to $3.06, then to $5.36” — without the public or lawmakers getting a say.

He added: “It is particularly notable that during this period, the Standard Premium Rate itself was not increased but the council’s draw from its funds were.

“For the CEO to say the allocation ‘has not changed since 2021’ is either wrong or relies on a definition of ‘allocation’ that the public have not been given.”

The Standard Premium Rate, which is a mandatory government-run feature of health insurance, is composed of the Standard Health Benefit premium and a portion of the Mutual Reinsurance Fund. The rate, which last increased in 2021, is set to rise this April 1 to accommodate a rise in back pay for hospital staff.

Mr Pitcher said: “Bermudians paying into the Mutual Reinsurance Fund deserve a straight answer. How much of the standard premium goes to the health council in 2021, 2023 and today?

“If the $5.36 figure is wrong, the council should say so and correct its published material. If it is right, the CEO should correct his statement and explain how the 2023 increase was approved and why it was not communicated clearly.”

This week, Dr Brathwaite responded: “We do not believe it is helpful to continue debating technical matters of this nature through the media. We remain available to engage directly with anyone who has genuine questions.

“At the same time, we take seriously any suggestion that the integrity of this organisation or its financial stewardship is being undermined. We are confident in both.”

On the apparent 2023 increase, Dr Brathwaite said: “I think what we are seeing here is a mix of three different things being brought together: the overall Standard Premium Rate, how that premium is allocated and the role the council plays within that system.

“First, the Standard Premium Rate itself has only been increased twice in recent years, in 2021 through legislation and now in 2026 following an independent actuarial review. Between those points, the premium remained unchanged for over four years.

“In simple terms, there has not been an increase in what the council receives. What has changed is how existing funding is presented. What changed in 2023 was not the total premium, but how that fixed amount is structured and grouped.”

He added: “For example, system oversight and programme funding were combined, which is why the figure appears to move from $3.06 to $5.36. That reflects a reorganisation of existing funding — not a new or increased allocation.”

He said the combined figure included components that previously were held separate, including $3.06 in core system oversight funding, $1.80 for the Innovation Fund, $0.50 for kidney transplant co-ordination

“This structure is not new,” Dr Brathwaite said. “To put that plainly, in 2016 the council was managing approximately $1 in core funding and $6.19 in programme funding, a total of $7.19. Today, those combined functions are reflected in a total of $5.36.

“So on a like-for-like basis, the overall funding being managed has not increased; it has reduced.

“On the legislative point, the Government has acknowledged that the prescribed sums following the 2021 changes were not formalised in the required way at the time, and legislation has since been introduced to validate those payments. That is a technical legislative correction, not a reflection of how funds were managed.

“The allocations themselves went through the established premium-setting process, supported by analysis and Cabinet review. They were not made arbitrarily.”

Dr Brathwaite said the council did not take money from clinic services, but kept itself to administration and “making sure the system works better for patients”.

He added: “It is also important to recognise that the council’s role today is broader than it was historically. While the legislative mandate has always been wide, much of that work used to be supported externally, including through consultants.

“As the system has evolved, more of that work has been brought in-house, and additional responsibilities have been formally transferred as part of system reform.

That is not mission creep. It is the system maturing.”