Everyone in Bermuda should have access to basic health care according to Bermuda Health Council head Jennifer Attride-Stirling.

Two weeks ago the BHeC released a consultation paper recommending how the regulatory framework for private health insurance companies could be enhanced.

Suggestions included requiring all private insurers to provide the same basic package at the same price to everyone regardless of age or pre-existing condition.

Dr. Attride-Stirling sat down with The Royal Gazette to discuss why the changes are necessary, how Bermuda's current health care debate differs from the one now happening in the US and the financial impact the report's recommendations could have.

Currently private health insurers provide 51 percent of health care coverage on the Island.

Bermuda's insurance regulations were put in place in 1970.

It met the needs of society at that time, requiring employers to enrol their employees in group programmes.

A lower life expectancy meant health insurance premiums were less costly to retired persons. Society was also more healthy then, with less instances of obesity, diabetes and heart disease.

The regulations need to be updated to meet the needs of today's population and future projections, Dr. Attride-Stirling said.

One of the biggest changes would be the creation of a basic health care package offered at the same price irrespective of a person's age or pre-existing medial issues.

The Council believes that this would ensure everyone in the Country has access to health care and in the long run will drive down costs.

Details of what a basic plan should entail have yet to be ironed out, however Dr. Attride-Stirling said it should include primary care such as doctors' visits.

"You will always find some disparity in any health care system in the world," she said. "There are always decisions that have to be made, you cannot give everyone everything.

"But everyone should have access to basic health care and that is widely accepted by most providers and insurers.

"We would like to see primary care, such as doctors' visits, added to basic health coverage. Basic health coverage should protect your health and maintain your health.

"We would like to mandate this and require all private companies to offer the same package at the same price.

"The question that is difficult is 'how do we then make that a reality?'"

Improving access to primary care can decrease the need for unnecessary hospitalisations, she added.

As it stands now, people who are not insured must pay out-of-pocket for any doctors' visits. They can seek treatment from King Edward VII Memorial Hospital as, under law, the hospital is not allowed turn people away.

They are not billed for basic services however if they require surgery the individual will be billed for the services of the anaesthesiologist and surgeon. This means uninsured patients can be left owing tens of thousands of dollars, as was the case with Ms A, the single mother-of-three profiled on Page 1.

Moreover, the aim of the proposed regulations is to ensure the economic burden of providing everyone with basic health care is shared across the community.

Currently, in the private system, a 21-year-old pays a different price than a 68-year-old for the same package. Some companies charge women of child-bearing age more than they do men of the same age. This is because private firms use a methodology known as experience rating, factoring in what each demographic costs the company. The Government believes community rating, which spreads the cost across the whole population rather than increasing it for certain demographics, is a better option.

Bermuda's ageing population has made headlines of late with a focus on Government's comprehensive FutureCare plan, but Dr. Attride-Stirling said that was not the primary focus of the BHeC report.

"We are just as concerned about the people in their 20s who are not in education or employment and are uninsured," she said. "People who are self-employed or under-employed are just at risk of being without health insurance. These are segments of the population that have difficulty affording health care now."

Regarding the elderly she said: "I think it is unfortunate that the issue, that people are living longer and healthier lives, is described as a problem.

"Having an ageing population means people are living longer, and I don't think you will find anyone has a problem with that. It is not a problem, but it does need managing."

She noted that many countries in Europe have a higher percentage of the population over 65 than there is in Bermuda approximately 20 percent of Japan's population are seniors.

The raft of changes will also require private companies to adopt an automated system, increase their reporting requirements to the Bermuda Monetary Authority and rewrite policies in 'plain English'.

Dr. Attride Stirling said she did not believe the proposed changes would cause the cost of private health insurance to rise.

"What it will be is sharing the burden," she said. "In addition, mandating that all individuals purchase basic health coverage, at the same price, will increase the size of the risk pool and protect insurers against adverse selection."

Members of the public are encouraged to read the discussion paper and make any comments to the BHeC by the end of August.

And while the recent US debate about health care is helpful in that it illustrates other countries are grappling with similar health issues, that is where the similarities end, Dr. Attride-Stirling said.

"The US spends 16 percent of their GDP on health coverage; we spend nine," she said. "The US has 15 percent of its population without insurance we have between five and ten percent. Their system is very different from ours and their players are different. We are already offering more than the US."

The full report is available at www.bhec.bm.