Elderly to be moved as Bermuda Health Council cuts costs
Elderly patients are to be moved out of acute care beds as the Bermuda Health Council looks to stem a “crippling” rise in the Island’s health costs.The organisation claims that with bills running more than $30,000 a month per person, the hospital can no longer afford to house patients who don’t need to be there.BHeC CEO Jennifer Attride-Stirling yesterday warned that the cost-containment measures would have to be put in place within a matter of months.“There are some cases that end up in acute care beds for social reasons,” she said.“These are older people mainly, who may have chronic conditions and disability, where their family can’t or won’t take them, or people who won’t apply for Financial Assistance or don’t qualify.“There are about a dozen stuck there any time from three months to two years in a facility that costs $32,000 a month to provide care for them.“What we can do is introduce home healthcare as a Standard Hospital Benefit so when people need intravenous antibiotics or other healthcare services, they can get it from providers who can deliver this at home.“It’s more cost-effective and safer for patients. It can be done by private healthcare providers. Standard Hospital Benefit pays claims to private providers as well.”The move is among a raft of measures proposed to rein in the Island’s spiralling expenses.Dr Attride-Stirling explained: “It will require those patients to be discharged, and their families to be able to accept responsibility for them. It’s difficult, but not every case is one of ‘can’t’; some simply ‘won’t’.”She added: “That will be a challenge. We want to see this in place as soon as possible in the new fiscal year, but we’ve been working on this since October.”Dr Attride Stirling yesterday told Hamilton Rotary Club members that claims under the Standard Hospital Benefit — the minimum package for any health insurance policy in Bermuda — had risen by $50 million between 2008 and 2012, even as the Island’s insured population dropped by about 3,000 people.Since October, the Council has been examining methods of short-term cost containment to go in place by April.“Another area of concern is diagnostic testing. There is overuse across-the-board, but right now we are going to focus on the cost of diagnostic testing.”Allowing community providers to deliver Standard Hospital Benefit services, reducing the use of acute-care beds by non-acute patients and encouraging home healthcare coverage are among the upcoming measures.Key to getting hospital costs under control are measures to enable “social cases” to be discharged for home treatment, and getting it covered under the Standard Hospital Benefit.Dr Attride-Stirling said the BHeC had been examining cost-containment measures with the Health Ministry to “look at things we could do very quickly — priority items — which we’re trying to implement over the coming few months”.She added: “Cost-containment is a very easy sell.“It’s difficult to achieve, but what’s more significant is the implications — in order to reduce costs, you either have to reduce the price you’re paying, or the amount of activity. You can’t do the same amount or pay the same amount.“I’m fond of a quote from Mark Roberts from the Harvard School of Public Health: ‘Cost-containment for one party is usually revenue-less for another’. I would like to add that it usually means activity reduction in the system.”It is hoped that the measures will enable cost-containment to be evaluated by April of 2014, she said.And Dr Attride-Stirling warned: “The level of increase we’re seeing in healthcare costs is not just unsustainable — it’s crippling.”In the meantime, she said, healthcare premiums can be expected to rise in the year ahead.“They go up every year. Anyone who thinks they will not go up this year is in for a disappointment.”Useful website: www.bhec.bmAre your loved ones affected by the KEMH move? Let us know what you think. Send your comments to news@rg.bm
We asked further questions of Bermuda Health Council CEO Jennifer Attride-Stirling. Below are her answers:
Q: Is it correct that there are about a dozen long-term patients who don’t necessarily have to be there?
A: It would be fairer to say that at any time there are about a dozen people who don’t need acute care but can’t be discharged safely.
Q: What happens to patients who have no home to go to? Will means-testing be done to determine if certain patients can stay?
A: Currently the cost for these patients is paid by insurers, subsidy, or the mutual reinsurance fund. Where these can’t be accessed the hospital is left with the unpaid bill. The intent is to make more cost-effective care available in the community that is payable under the Standard Hospital Benefit, as it is at the hospital. This way patients and families won’t be so dependent on the hospital, as home medical care will be covered.
Q: Can you give an estimate for the savings we’re looking at?
A: Currently an acute care bed costs approximately $32,000 per month. Home care will be significantly less costly, but it will also require families to help their loved ones.
Q: Is it correct that most of the people affected are elderly, and that their families have chosen to leave them in the hospital rather than look after them themselves?
A: That wouldn’t be entirely fair because we can’t quantify how many cases are due to genuine reasons or not. They are mostly older persons but can also be persons with disabilities who need some medical care, but not acute care. They remain in the hospital because the families can’t care for them at home either because they can’t afford the care or the time, due to work or other commitments. Undoubtedly there are cases where families don’t live up to their responsibilities, but most people don’t want their loved one in such a situation. The problem we are trying to fix is to enable home medical care to be covered to remove some of the dependence on the hospital.
