FRIDAY, DEC. 21: The Bermuda Sun has teamed up with the Bermuda Health Council to answer your questions about the island’s healthcare system. This edition will look at how you can reduce your healthcare costs. Visit www.bhec.bm to submit your queries and look for our response in the Bermuda Sun on the last Friday of every month and on www.bermudasun.bm

 

Question: While travelling in the United States recently I fell and wound up in an emergency room. The doctor who saw me was excellent and ran a number of tests but said when I returned to Bermuda I should have a CT scan to figure out what was wrong.

When I returned to Bermuda I relayed his message, however, my local doctor told me that I would have to see a local surgeon before I could get the CT Scan!

How does this make sense? Isn’t my doctor just asking me to spend more money for nothing?

Answer: This situation is understandably distressing to patients, but it is essential to manage appropriate use of health services. In any health system access to expensive and high-risk tests requires referral of the relevant professionals within that system.

For example, an American tourist told in France that they need a medical test when they return home is unlikely to have it covered by their insurer, unless their US-based doctor says they need it.

The same applies in Bermuda. Your local doctor who knows your history is well placed to help judge what tests you may need. A patient who is not comfortable with their doctor’s view can seek a second opinion. In this case, the specialist could provide that.

 

Question: Physicians and dentists sometimes send bills to patients a year or more after the service has been provided. Is there a time limit when a person is no longer obligated to pay the bill? In most instances a patient doesn’t even remember the event or no longer has the receipt to prove service already has been paid.

Answer: If the service took place before July 31, 2012 then the patient’s obligation is given by the Limitations Act 1984 which sets six years as the maximum time a business can bill after the date of service.

However, if the service was received after August 1, 2012, then the provider has one year to bill for the service.

This is established by the Health Insurance (Health Service Provider and Insurers) (Claims) Regulations 2012, section 11(2), which state that claims 366 days after the date of service are “expired” and not payable. The Claims Regulations are better known for having banned most upfront charges, but they also set in place a number of other billing requirements, including expiration of claims. You should also be aware, however, that sometimes third-party companies are hired to prepare and send out late bills to patients. 

When this occurs, patients should check with the insurer and determine if the insured portion of the bill has been paid to the provider prior to remitting payment.

 

Question: I often hear doctors being blamed for health costs being high, but my experience is that they generally do the best for their patients and some don’t even charge if they know a patient is going through hard times. So, why then are our health costs so high in Bermuda and how can we bring them down?

Answer: The total amount a country spends on healthcare is, at its most basic, the result of just two things: the price of services and the amount of services consumed. In this sense, healthcare is like any other good or service — although the difference ends there. Cost of living is high in Bermuda so, naturally, prices are also higher than elsewhere.

But our total health spending is disproportionately higher than other countries’, and this is largely explained by the volume and type of health services we consume.

We have enough evidence to see certain areas of Bermuda’s health sector are overused.

These include very high rates of diagnostic testing; hospital stays that are too long for some patients who don’t need acute care but can’t be discharged for social reasons; increased use of the emergency room (which is more costly than a GP visit); and our high rates of chronic health conditions (and the way we treat them) are also leading to higher spending.

Going forward, there will be only one way to curb health costs: to use less health services, and/or pay less for them.

Jennifer Attride-Stirling is the CEO of the Bermuda Health Council.