Evans: Dutch healthcare model could work here
Bermuda would do well to study the healthcare system of the Netherlands as a possible model for the island in the future.
That's the view of Bermudian health economist Aaron Evans, who works in the industry in Europe.
The former national team track athlete has a master's degree in health economics and has experience in the sector with the likes of Johnson & Johnson, and Boeringher Ingleheim. He has familiarity with the healthcare systems of a number of European countries, and currently works in Barcelona, Spain.
He has learnt things that he would like to see implemented in Bermuda, and has ambition to further his knowledge and expertise in medical technology and innovation and new therapies.
In addition, he has ideas on how Bermuda can evolve its healthcare landscape for the benefit of everyone.
“In Bermuda, I would like to see many things implemented that I've learnt overseas such as having our own clinical guidelines and treatment pathways for the most prevalent diseases, better data collection, and the adoption of health technology assessment techniques that are already used overseas,” he said.
“Healthcare costs in Bermuda rise because of the lack of competition between insurance providers. Healthcare should be fair with equal access. Bermudians would benefit from a managed competition model, with standardised coverage contracts set by the Government where there's no tricky exclusions.”
He said there is no perfect system, but Bermuda should draw inspiration from the best features of different countries.
“One country that could serve as a model for Bermuda is the Netherlands.”
He said the healthcare system there is insurance-based; people have to buy health insurance by law.
“However, for insurance companies to be in the market, these must provide a basic coverage package, regulated by the government, at a competitive and accessible price,” Mr Evans said.
He also believes that no Bermudian should be refused coverage because of a pre-existing condition.
“Those without health insurance should receive so subsidised by government. Government, through an insurance pool, also could compensate insurers for signing up people with poorer health or pre-existing conditions.”
The healthcare field was not something Mr Evans had in mind during his youth. His talent as a runner led to him becoming an international athlete. A career highlight was reaching the 800m semi-finals at the 2014 Commonwealth Games. He also won silver and bronze medals at the distance at the Carifta Games, and he still holds the Bermuda national record for the 800, which he set in 2010.
However, injuries led to him hanging up his track spikes. Initially, he spent a year as a physical education teacher at Purvis Primary, this helped him overcome the disappointment of not reaching his full potential as a professional track athlete.
Family and friends assisted as he looked for a new direction in life. He already had a degree in economics and decided to return to studying, this time for a master's in health economics at City University, London.
He chose health economics, an area he found interesting and something that he could see “the value in bringing the skills gained to Bermuda”.
The master's degree led to him working with the neuroscience team at Johnson & Johnson alongside their National Institute of Clinical Excellence submission.
“This was a good choice for me because it was a chance to work on a health technology assessment for a new pharmacotherapy that had never been on the market before,” he said.
He now works in the Barcelona office of Swiss consulting company Amaris.
“Spain has one of the best national healthcare systems in the world, so it was a great chance for me to learn from other professional in a free and universal healthcare system.”
Evans's work as a health economist has been broad, although a large part has involved assisting pharmaceutical companies in preparing for their European HTA [health technology assessment] submissions.
He uses the most quality, robust data from clinical trials on new drugs and therapies that can be used to support the HTA process.
“This is the basis of value-based healthcare. Governments like the UK that pay for their citizens' healthcare, weigh the clinical and economic outcomes of new drugs equally, only reimbursing drugs that are deemed cost effective,” Evans said.
Of his own ambitions going forward, he hopes to work on the next generation of modern medicines. He has a profound interest in technology and innovation, gene therapy, personalised medicine, and DNA gene sequencing.
“I am interested in how to overcome the challenges of bringing these new therapies to market. These therapies target rare and ultra-rare diseases, thus suboptimal clinical evidence is expected and a possible efficacy-effectiveness gap should be accounted for,” he said.
“In some cases, these are very expensive drugs but curative. Nevertheless, over a patient's lifetime horizon these may be deemed cost effective.”