Opposition MPs last night demanded a better explanation from Government as to why it spent an extra $15 million last year on a subsidy for King Edward VII Memorial Hospital.

The Budget for 2009/10 gave an original estimate of $85.6 million for the subsidy — but the revised estimate given in the House of Assembly by Finance Minister Paula Cox yesterday was $100.6 million.

Health Minister Walter Roban said the extra $15 million — the exact same overspend as the previous financial year — was "directly related to utilisation of services" at the hospital.

Mr. Roban said the subsidy covered services accessed by seniors, youth and indigent patients, as well as outpatients and those needing haemodialysis.

"Utilisation is the main driver of the subsidy," he said. "Each year an estimate is set, since the subsidy is paid as a fee for service. The final amount paid is directly related to utilisation and, to date, has been about 13 percent higher than estimated."

The Minister said the number of long-stay patients — both old and young — during 2009/10 accounted for some of the overspend. "These are people who are unable to leave the hospital as they do not have a safe environment in which to be released, even though they no longer need hospital care." He said Bermuda Hospitals Board was working with Government to tackle the problem.

Shadow Health Minister Louise Jackson questioned why Government didn't budget an extra $15 million for the subsidy having overspent the same amount in 2008/9. "I can't understand why they didn't learn from last year, and the year before, that they were going to need $15 million."

Shadow Finance Minister Bob Richards said: "I don't understand how this thing could come up every year and it not be part of the original Budget that we approved in this House. It's not as though those old people in the hospital just materialised this year."

Shadow Education Minister Grant Gibbons said that for 2008/9 the subsidy overspend was $6 million. "Why did it jump from $6 million to $15 million?" he asked. "Is it an increase in the cost per claim? Surely if you have $15 million of overspend you can come to the House with a breakdown."

He added: "Surely just coming in saying it's utilisation is insufficient for the oversight of this House. It is fair to guess that $15 million is not the end of the story here. The explanation given so far is totally inadequate."

Premier Ewart Brown said Bermudians failing to take care of their aged parents contributed to the $15 million overspend. "My experience has been that at our hospital we have too many cases where children of elderly put them in hospital and leave them."

Dr. Brown said people refused to return to the hospital to collect parents once treatment was complete, giving excuses such as trips abroad or being too busy. "It happens too often and it's costly and it's more costly than it used to be."

He said lots of Bermudians with private health insurance were letting Government pay for their children's medical bills between birth and age 16. "That, I think, is cost-shifting at best and the Government will take steps to fix that."

In response to the Opposition criticism, Mr. Roban reiterated: "Long-stay is what is responsible for this subsidy."

He said there were about 40 long-stay patients at KEMH. "It's a lot but we had a plan to reduce that. I expect it will be dealt with over time."

He told MPs: "There's been a supplementary for the past 23 years for the hospital. We endeavour to do better at all times and work on the hospital to observe and manage its cost, so we don't have to come back with less, but there are other pressures with seniors. We initially thought we had got a handle on it but the realities, as the Premier said, are something we have to face on a regular basis."

The Minister added: "This figure for the supplementary is final. We expect this to be the end of it."

The overspend was approved as part of the $23 million Supplementary Estimate No. 1 for last year.