January 30, 2013 at 5:54 p.m.
National Health Plan
Equality a key aim of sweeping health reform
Government, the Bermuda Health Council and Bermuda Hospitals Board are seeking to implement 11 goals by 2018.
But the principles of universal access and “proportional financial burden” are expected to be achieved by 2013.
The goals are:
Universal access to basic healthcare coverage, for all residents.
Basic health coverage will include urgent physical and mental healthcare, hospitalization, primary care, preventive care and health maintenance (such as screening, counselling and treatment). Bermuda’s basic Standard Hospital Benefit package will be widened, to also include financial risk protection.
The Plan aims to design a level of coverage “affordable for Bermuda” by next year;
Health coverage contributions will be based on ability to pay;
Overseas care will be streamlined to cut costs. The Plan says overseas care has “contributed the greatest increases to overall health expenditure, having risen by 106 per cent between 2004 and 2009 (or an average 21 per cent per year)”.
As well as cost-containment, over the next two years strategies will be developed to streamline referral overseas of “medically necessary cases” and to use hospitals that are most “cost effective”;
More efficient mechanisms will be established to pay healthcare providers. A reform of the reimbursement system will regulate fees to providers “to ensure affordability and financial sustainability”.
The Plan notes that in Bermuda, “more than half of health care expenditure is attributable to services with unregulated fees”. The system will have new mechanisms to review oversight of regulated fees and expand this to non-hospital care;
An integrated health IT system will improve efficiency and patient care by collating data on individuals and populations;
Strategies will aim to meet the needs of people with chronic illnesses, physical, cognitive and mental disabilities. Coordination of services is needed, to ensure both institutional and community care in the public and private sectors. Financing through “general taxation and social insurance” is preferred to private insurance as a means of funding;
The regulation and monitoring of healthcare provision. The Plan says the island has “limited mechanisms” to monitor the quality of healthcare by individual providers.
“There are insufficient mechanisms to deal with patients’ concerns with respect to quality and billing, and inadequate provision for professional peer review or clinical audit.” The Plan aims to increase oversight and care to “assure patient safety”;
Cost-effectiveness throughout the health system. Government will look to international models of health care. But the Plan states: “Private insurance will continue to play a significant role in health care financing in Bermuda”. Financial models to identify cost-effective financing mechanisms are expected to take three years to complete;
Regulation of health technology to maximize resources. Bermuda pays significant amounts on imported pharmaceutical drugs — a tenth of health expenditure in 2004. Policies will be reviewed to enhance affordability of prescription drugs, with a possible list of essential drugs with regulated prices;
Promotion of healthy lifestyles. In 2007, 77 per cent of all deaths in Bermuda were due to non-communicable diseases such as heart disease, cancer and diabetes. These are linked to obesity in the community. The Plan says inactivity and poor nutrition has led to 64 per cent of the population being overweight or obese. Other problems are respiratory diseases, STDs, mental illness and substance abuse. Health promotion and education is already underway in the Well Bermuda Strategy.
Government’s plan provides no detail about funding or how its proposed reforms will be implemented.
The Ministry of Health will report bi-annually on progress of the 11 goals “to ensure accountability and timely completion”.
Progress will be judged using 100 performance indicators developed by the OECD (Organization for Economic Co-operation and Development).
The need for a National Health Plan was announced in the 2009 Throne Speech.
The 2011 Plan states: “The need for this initiative arose from ongoing long-term concerns about healthcare costs, weaknesses in our healthcare system and its inability to meet the needs of contemporary Bermuda.”
Our health care system was established by the Health Insurance Act 1970.
Rising health care costs above inflation, growing unemployment, and economic, social and demographic changes have made the model outdated.
Weaknesses
Mr. DeSilva said 15 reviews in the last 17 years have highlighted weaknesses in the health system.
He said the recent report ‘Health in Review’, by the Bermuda Health Council and Department of Health, showed “health care costs are escalating too quickly for individuals, employers and the Government”.
“We need sustainable growth,” he said.
The cost of coverage was also “disproportionately high” for the sick, elderly and low-income families.
The National Health Plan will seek to provide universal access to basic healthcare with contributions based on the individual’s income.
The Plan says Bermuda’s strengths “must be maintained and built upon”.
These include: a strong public health sector; good personal care provision; access to high-quality overseas hospitals; sufficient manpower and infrastructure capacity; high overall level of financing; and Government subsidies for vulnerable populations.
It states: “To control increases in health care costs beyond growth in national wealth will require significant reform to the system and considerable sacrifice for some healthcare providers, administrators and the public.”
National Health Plan 2011
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