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Move to tackle crippling health bills

Jennifer Attride-Stirling

Health bosses are exploring ways to tackle crippling healthcare bills as a new study shows Bermuda costs twice as much as other islands.

The Island’s healthcare figure of more than $10,000 per capita per year dwarfs that of all other 14 islands, including nine countries in the Caribbean, in new research by KPMG.

The survey, “Key Issues In Healthcare, An Island Perspective”, reveals Gibraltar comes second with about $5,000 per capita, with every other Island about $4,000 or less.

Jennifer Attride-Stirling, the new permanent secretary for the Ministry of Health, pointed to a large amount of services being used on the Island — sometimes, she said, without any health benefit.

High levels of poorly controlled diseases like diabetes and the ageing population were further reasons for Bermuda’s soaring costs, according to Dr Attride-Stirling.

Bermuda Health Council acknowledged Bermuda has a long way to go before patients get value for money, and said it is pursuing initiatives to bring down costs.

The survey from KPMG was based on healthcare costs per capita rather than the international standard of using purchasing power parity which eliminates the difference in price levels when comparing the same goods.

According to the most recent figures from the World Bank, it requires $1.60 USD to purchase goods in Bermuda compared to the $1 USD that would be required to purchase the same goods in the US.

As well as Bermuda and Gibraltar, it gives estimated costs of about $4,000 for Isle of Man, Guernsey and Jersey; about $2,000 for the Bahamas, British Virgin Islands, Cayman Islands, Malta, Turks and Caicos; and lower still for Barbados, Jamaica, Sint Maarten, Suriname and Trinidad and Tobago.

Bermuda and Gibraltar do have the highest hospital bed capacity at seven per 1,000 people with Malta trailing in third place with 4.45 beds. And with a life expectancy of about 81, Bermuda is among the six countries higher than 80.

Tawanna Wedderburn, acting chief executive officer for the Bermuda Health Council, said that Bermuda’s healthcare system is complex and that the Island has a long way to go to achieving value for money in relation to life expectancy.

“The Health Council is analysing data to see how the health system can achieve greater efficiencies in areas such as overseas care which represents $100 million or 14 per cent of total health expenditure,” she said.

“The Health Council is pursuing a number of initiatives in collaboration with stakeholders to address key drivers of costs. In addition, we continue to examine ways that yield long-term cost savings and can improve the health of the population by reviewing the Standard Health Benefit (SHB); the basic package of care that every employed person and their non-employed spouse is required to have.

“For all SHB services, there are no co-payments for patients. A very good example is the Home Medical Services Benefit which saved the health system an estimated $100,000 in the first six months. This benefit allows patients to receive specific medical procedures in their home as part of their insurance policy.

“It is natural to want to blame others but, in a system where total health expenditure is $705 million, we all have a role to play in improving our health spending. We can begin by choosing the types of services that are truly proven to enhance our health and longevity.”

Dr Attride-Stirling said several BHC reports had highlighted health cost trends.

She said: “From these trends we can see the main drivers are the amount of services being used, at times with no health benefit; high levels of chronic non-communicable diseases (NCDs) that are poorly controlled, such as diabetes; and the fact that our population is getting older which naturally comes with more need for healthcare.

“In addition there are efficiencies to be gained with respect to healthcare delivery and financing in our health system.

“There are many initiatives under way to reduce costs and, in fact, we are seeing some green shoots already. We know diagnostic test ordering has gone down, the Standard Health Benefit includes more coverages to drive care to more appropriate, cost-effective settings, for example Home Medical Services, and various initiatives to better manage NCDs will also improve care quality and reduce costs.”

Steve Woodward, managing director at KPMG in Bermuda, said: “The survey findings show that island healthcare systems are experiencing the combined challenge of rising costs, increasing demand and greater patient expectations. Island governments have the added challenge of finding the optimal balance between providing care locally or abroad.”

The BHC provides advice to help mitigate high costs while avoiding unnecessary testing or inappropriate use of emergency services.

Information is available online at www.bhec.bm including the Guide to Bermuda’s Health Costs which details how to use services correctly, understand prices and reduce the need for care. There is also a healthcare directory which allows patients to choose among the options available for care.