As of June 1, 2017, the cost of kidney dialysis will be decreasing to reduce the $34 million annual expense of treating some 170 patients on dialysis in Bermuda, at a cost of $200,000 a year for each patient.

Health insurance coverage for kidney transplants will also increase, making transplants more accessible for some patients “so they can come off costly dialysis and have better quality of life and better productivity”. This from Health Minister Jeanne Atherden, while addressing the Association of Bermuda Insurance Companies (ABIC) on the Bermuda Health Strategy and Action Plan.

“A transplant can cost $130,000 a year so it is an effective cost-saving measure,” the Minister. “Chronic kidney disease is very costly to the island, and we all pay for it through our premiums.”

Highlighting the “strategic initiatives” formally launched in January “to reform and improve the quality and sustainability” of Bermuda’s healthcare system, she said the main goal “is to ensure Bermuda has quality healthcare that is accessible, affordable and sustainable, in order to achieve the Ministry’s vision of ‘healthy people in healthy communities’.”

A further Action Plan “was put in place to address key long term care issues as well” with “key partners to implement initiatives to achieve the goals for health” over a five year period.

* Photos Courtesy of DCI

To address the needs of 21st century Bermuda, the Minister said: “What is clear to Bermuda is that we could not afford the trajectory it had been on for 20 years. With an under-regulated sector health costs have increased exponentially and numerous past attempts at reform failed. As a result, the problems we have today are just bigger, more expensive versions of the problems that plagued us 20 years ago when the seminal Oughton report was commissioned.

“However, on this occasion we have been absolutely determined not to fail, and our approach with the Strategy and Action Plan is working,” said the Minister.

“The most important indicator telling us we’re on the right track is the National Accounts report. This report monitors annual total health spending and the latest report shows that in 2011 health spending began to level off, and in 2015 total health spending actually went down by 1.1% for the first time on record. We finally bent the cost-curve – and we’re the first country to do so, compared to the OECD. This tells us that we are moving in the right direction, but we’re the first to recognize that at $11,102 per capita health expenditure, we are still spending too much and have some way to go to achieve sustainability.”

She also stressed “that the way we use health services is a key part of reform, because for health costs to be brought under control and for premiums to become affordable, people need to be healthier, chronic diseases need to be managed better to avoid future costs, and we need to use health service responsibly, in ways that give good value not just more volume”.

“To make our health system sustainable all of us have to change, and every resident of this island has a part to play,” said Ms Atherden. “To date, we have made strides in all areas, though you’ll be aware that some of our reforms have struggled in the face of opposition from some sectors of our community.” And she said: “Chronic non-communicable diseases have become central to our combined efforts in cost-reduction.”

To that end, the Patient Medical Home and the Enhanced Care Pilot programme was launched to target “under- and uninsured persons with expensive chronic conditions who have been stuck in a revolving door of preventable hospitalizations”. To date, there are “more than 100 persons enrolled in these programmes run by BHB and the Health Insurance Department “.

“This is a win-win for everybody: patients get better and the system pays less,” said the Minister. “In addition, long term care is a key priority area for the Ministry.” But she said: “Long term care is not just about bricks and mortar. It’s also about support for care-givers and workforce capacity. As such, health workforce planning has been a key initiative and is under active consultation at present.”

Legislation is now being drafted “to improve care quality in residential and nursing homes’, and “the Mental Health Act is under review”. A ‘Personal Hoe Care’ benefit has also been introduced that enables “persons to be cared for at home safely and more cost-effectively”.

“This new benefit has been especially successful and one private insurer has already incorporated it to its own policies. We are working with other insurers to follow suit as it is great for patients and much less costly. We have also begun a project to stimulate private sector investment in long term care,” she said.

“We know the need for additional capacity is great, as you will have seen from the recent and current bed crisis affecting the hospital. There are approximately 120 long-stay patients who do not need hospitalization, but have no other place to be cared for. This Government cannot build this capacity, so we are looking to the private sector and are in active discussion with developers and potential financiers to mobilize this sector.”

But when it comes to better regulation of the health sector, the Minister acknowledged both “some wins and some set backs”, particularly as it relates to regulating healthcare businesses. She conceded that Government has “not yet been able to pass legislation” in this area. “This is naturally frustrating as this regulation is paramount to control the unrestrained utilization of healthcare resources which has contributed so much to the increase in health spending.

“However, I remain committed to introducing the necessary regulatory controls, and hopeful that the Bermuda Health Council Amendment Act will ultimately be passed,” said the Minister. That would be in spite of the objections cited by healthcare professionals.

Progress in other areas has been “slower” than she would have liked. But she said the standard premium rates for HIP and FutureCare will go down, for the first time ever on June 1st. “This will be a significant help to seniors and persons on low incomes struggling to retain their coverage,” the Minister said. “The price of diagnostic imaging fees at the hospital will be brought down to the level charged in the community, and the price of long-stay beds at the hospital will be reduced for eligible patients. It is estimated that these combined changes will reduce costs by over $20 million in one year. If successful, it will represent the single largest reduction in health costs our system has ever seen.”

But she stressed that “these initiative are barely the tip of the iceberg” because the bottom line is “health is fundamental to the core of our economy”. “Sick people can’t work, sick children can’t learn, sick teachers can’t teach, and sick people require a tremendous resource investment that should be the exception, not the rule,” said the Minister. “This is why health is so vital to Bermuda’s prosperity, and why ‘Health People in Healthy Communities’ is my vision Bermuda.”