What should Bermuda’s health care system provide for our citizens?

That’s one of the questions posed by BermudaFirst in their Future State Report commissioned by the Premier and released last month.

Like many governments, the report said the Bermuda Government is wrestling with some of “the most complex and challenging” issues facing society.

“Bermuda is in a crisis state, with our present circumstances having deteriorated to a point where immediate intervention is required,” the report said.

“The recently announced reforms by Government lack a holistic method and will have unintended consequences that will only
exacerbate the existing challenges.

“Further, the fact that our citizens’ own lifestyle choices have made Bermuda one of the least healthy populations in the world, with unacceptable levels of chronic, preventable diseases (ie diabetes and heart disease) resulting in overburdening financial impacts, should be a wake-up call for us all.”

While noting that the work of the Health Care Working Group “is substantive and represents a thoughtful and thorough response, deserving of careful consideration”, BermudaFirst also supports ” the convening of a new team of resources”.

“Given the clinical partnership we are currently negotiating with Johns Hopkins’ Medicine,” the report recommends that “we should utilise this relationship…in advising on the design of health care systems”.

“Ignoring the advice of best-in-class experts, in this instance, would be pure folly and would certainly lead to under-informed choices.

“Bermuda cannot afford to delay leveraging this and other similar, influential resources.

“Given that Health Care represents the largest expenditure of the Government, getting control of this cost and implementing a sustainable long-term solution is a high priority,” the report added.

“We must also ensure that the regulatory oversight is best in class and mirrors the reputation and quality found in the Bermuda Monetary Authority.

“Bermuda deserves nothing less. Further, regulatory oversight of physician and medical practices should be the responsibility of the Bermuda Medical Council.

“We believe that these recommendations require courage and commitment, and that we must avoid dilutive compromise.

“The old dynamics that determined market cycles no longer apply and those simply waiting for a market change will eventually be challenged for relevancy,” the report added.

“The drive to ensure that our infrastructure is internationally cost competitive is relentless and the impact on human capital has been felt by all of us.

“It is in our DNA to respond to the opportunities that come from change…and we are confident in Bermuda’s ability to fine-tune our model so that we remain relevant.

“We appreciate the Government’s financial support and the Premier’s courage in commissioning this report to obtain objective, external advice. After this report is reviewed by the Premier, BermudaFirst stands ready to develop the implementation plans for those priorities, which will enhance the lives of Bermudians and provide citizens with the tools and opportunity to realise their full potential.

“This aspiration has always been BermudaFirst’s vision for our island.

“This journey requires leadership, courage, a call for personal accountability, commitment and a willingness to change.

“This is not the first time the people of our country have had to choose between making a major change or being left behind. We have successfully reinvented ourselves throughout our history. Now is the time to do the same,” the report said.

“Join us on this journey to a better, fairer Bermuda.”

In terms of demographics, the report warns: “Seniors will soon make up a quarter of our population .

“That has never happened before. Normally, there are enough people working whose taxes and insurance premiums can cover the costs of health care, education, pensions and financial assistance,” the report said.

“As our population shrinks and ages, we will find it more difficult to cover those costs. Further, as our working population shrinks,
so too will our ability to maintain the present standard of living.”

Ultimately, the report said: “The changing demographics of our community impact the economy.”

BermudaFirst also stated: “Our history is not one of political and economic inclusion.

“In our past, political and economic policies were implemented to systematically hold back black and working-class people.

“Institutions were put in place to benefit an oligarchy. Remnants of that non-inclusive system are still with us today.”

But in a ‘not so well’ Bermuda, the report added: “To a great extent, preventable diseases from unhealthy lifestyles have driven health care spending to an unsustainable level.

“Some studies suggest that at least 50 percent of health determinants are due to individual behaviour.

The facts, according to BermudaFirst, speak volumes:

  • In 2017, approximately 17% of adults had chronic disease due to poor lifestyles
  •  We will never be able to achieve a sustainable and effective health care system if we do not encourage personal accountability. Yet Bermuda also seems to be lightly delusional when it comes to dealing with this. In a recent Vital Signs Survey, 83% of people surveyed suggested their health was either good, very good or excellent. Yet a STEPS to a Well Bermuda Survey found 75% of the population is overweight or obese

“This obviously needs to be reconciled,” the report said.

“Most would agree to a system of equal access and inclusiveness, but members of this system also need to be held responsible for their own health or all great intentions to control costs and improve efficiency will be wasted.”

Historically, the report said: “Bermudians have had to adapt to changes in political and economic forces beyond our shores.

“To survive, we had to be agile. We started this journey trying to sell ambergris and then turned to tobacco farming. When that did not work, we turned to the sea and changed the way the Atlantic World moved merchandise around British America and the Caribbean with the invention of the Bermuda sail and sloop.

“We are a small island, but we punched well above our weight in the maritime economy of the 1600s to 1800s, and we continue to do so.”

But moving forward, the report stated outright that “a shift in the mindset of Bermudians to want to become lifelong learners”.

“This necessary shift should help more of our people to feel valued.

“Greater inclusiveness will also require better access to health care. It is important, however, that it is not simply about access, but efficient and effective access.

“All Bermudians, regardless of their socioeconomic standing, should have access to necessary care and, perhaps even more importantly, information on how to live a healthy lifestyle and the support necessary to get there.”

On that note, the report said: “Bermuda’s model of health care must evolve to focus more on outcomes and value and less on the perverse incentives tied to a system that revolves around reimbursement of service.

“Any model that simply pays without due consideration of actual results leads to excessive utilisation at an ever-escalating price.

“A practice patient-centric outcome-based billing model is focused on value not price. To get there, all stakeholders in health care will need to be held accountable to acceptable world class clinical standards.

“We want Bermudians participating equitably in a growing economy. That realisation, however, will only come about with preparation, participation and personal accountability.”

  • More on the Future State Report by BermudaFirst in subsequent reports…