News

  • 28 Jan 2019 11:51 PM | Stephanie Lee (Administrator)

    Duncan Hall (Published Jan 28, 2019 at 8:00 am (Updated Jan 28, 2019 at 12:11 am)Costly system: the island's healthcare spending has soared over the past decade (Data source: the Bermuda Health Council)

    Costly system: the island's healthcare spending has soared over the past decade (Data source: the Bermuda Health Council)

    In the first of a five-part series examining the impact of the ageing of Bermuda’s population, we look at the healthcare sector.

    A shift in population demographics over the next seven years is expected to have a dramatic impact on the provision and cost of healthcare in Bermuda.

    Government expenditure on healthcare is already the largest area of spending in the budget, exceeding debt interest. The rising cost of healthcare is a serious burden for businesses, which are legally bound to provide healthcare coverage for their employees, while also being a drain on household income.

    According to a recent report, the current situation will worsen as the island’s population ages, resulting in increased demand for healthcare services, and a corresponding upward pressure on costs, at a time when Bermuda’s health system share of gross domestic product — 11.5 per cent — is already the third highest among Organisation for Economic Co-operation and Development countries.

    Only the US and Switzerland outstrip Bermuda in that regard.

    The island’s shifting population demographics, as outlined in Bermuda’s Population Projections, 2016-2026, means that, based on current projections, the proportion of the population 65 or older will rise from 16.9 per cent in 2016, to 24.9 per cent in 2026. This will occur as life expectancy increases and large groups born during past periods of high fertility become older. The overall population will decline by 111 people by 2026 as the number of deaths exceed births.

    The increase in the number of retirees will be mirrored by a corresponding decrease in the number of people in the workforce paying into the system.

    According to the United Nations, a country in which more than 7 per cent of its population is over 65 is considered “aged”; Bermuda reached that milestone in 1980. By 2026, one in nine of us will be 75 or older, increasing demand for long-term care. The median age will be 49.

    The old-age dependency ratio, which measures the ratio of the population 65 years and over to the working-age population (15-64), is expected to soar from 24.7 to 39.9 by 2026. This means that there are expected to be 40 seniors for every 100 people of working age. The ratio is used as a gauge of a society’s capacity to maintain the quality of life of its seniors.

    Citing 2010 census data, the report says that 77 per cent of seniors had a long-term health condition compared with 35 per cent of persons under 65. Moreover, 14 per cent of seniors had a disabling long-term health condition in comparison to 4 per cent of the population under 65. Overall, 40 per cent of the population reported having a long-term health condition in 2010 compared to 18 per cent in 2000.

    The island’s Fiscal Responsibility Panel said in a recent report that our ageing population will result in increased demand for more or larger retirement facilities, senior citizen daycare programmes and in-home care services. It agreed with the population projection report’s findings that purpose-built residential facilities with trained staff for very elderly residents with chronic health challenges would be required in future.

    John Wight, chief executive officer of BF&M Ltd, a health insurer, said it was important that the island develop new healthcare facilities.

    “One important aspect of the current healthcare model which needs to be understood and addressed relates to the setting where many residents receive their care,” Mr Wight said. “In the early 1970s, the Hospitals Act came into force at a time when it made sense to drive people to the hospital for medical treatment. In 2019, we have to re-examine that approach and work on a new model of treating residents in the most efficient and cost effective manner, which often is not the hospital. We need to have a healthcare system that is flexible, where there are facilities other than the hospital to care for our aged population. Our lack of facilities is a critical issue both financially and emotionally for families as their loved ones grow older.”

    Mr Wight’s colleague at BF&M, Michelle Jackson, agreed. “A lot of families have a loved one at the hospital because there aren’t very many options if you don’t have the finances,” said Mrs Jackson, senior vice-president, group lines, health and life, at BF&M.

    “Long-term care is a huge issue in Bermuda. The hospital can’t be the place where people seek long-term care, it’s not ideal. Generally, we want to get out of the hospital as soon as possible. It is not the best place for people to age well.”

    The panel also pointed to rising demand for medical services from the more elderly segments of the labour force (over age 50) with annual per capita claim costs for outpatient services rising by more than 50 per cent in 2017.

    “[That rise] contributed to a 6.4 per cent increase in the Standard Premium Rate in 2018-19 and even larger increases in the premiums charged for supplemental private insurance schemes. The premiums paid by the Government on its much more comprehensive health insurance plan — the GEHI — may have to rise at a much faster rate than the SPR, most likely between 12.5 and 15 per cent.”

    The panel said it warned in its 2017 report that over the medium and long term, the cost of healthcare must be addressed. “The island’s costly healthcare system risks overwhelming the budget and the whole economy as the population becomes increasingly elderly and frailer, with more and more requiring long-term care,” the panel wrote. “We said it would be important to pursue with determination measures to control and reduce costs and to better target government subsidies to those most in need.”

    In its more recent report, the panel said measures must include:

    • Encouraging elderly residents with chronic diseases to use more cost-effective prevention and treatment within the community rather than make costly hospital visits.

    • Devising a more effective approach to the treatment of some chronic diseases, pointing to the rising incidence of kidney disease on the island and the $20 million annual cost of dialysis treatment for the less than 200 people in Bermuda requiring such treatment.

    • Developing for all of us — seniors included — greater on-island treatment of certain categories of inpatient care in order to reduce expensive overseas trips for treatment as well as partnering with insurers and designated overseas hospital centres for the treatment of Bermuda residents. “We are encouraged by the recent partnering agreements with the Johns Hopkins University for on-island treatment and the work of the Health Insurance Department to explore opportunities for care in low-cost settings with good health outcomes,” the panel wrote.

    • Making health insurance mandatory, and revisiting Government’s annual block grant of $30 million that is used to subsidise healthcare for children, the indigent and the elderly in order to redirect subsidies for those who do not have healthcare covered by employers — and, using means testing, allocating premium subsidies for anyone who meets set criteria related to income and health status (irrespective of age). This, the panel says, would also result in a fairer and more satisfactory outcome for the health condition of all Bermudians.

    • Broadening the coverage of the standard health benefit to include prescription medications, preventive care, and access to providers that offer effective disease management (rather than being limited only to hospital care).

    The panel said it was encouraged by Government’s efforts to begin to address some of the sources of chronic disease in Bermuda. “Witness the Bermuda Health Strategy, the Bermuda Health Action Plan, the Long-Term Care Action Plan, and a number of initiatives to contain costs and promote a healthier lifestyle (the Enhanced Care Pilot, the Patient Centred Medical Home, and the Personal Care Benefit),” it wrote. “The new 50 per cent duty on sugary soft drinks, candies and pure sugar imports (which will be raised to 75 per cent in April 2019), represents a further initiative. The revenues to be raised (roughly $10 million in a full year at the higher rate) should be clearly seen as earmarked to specific programmes that expand health promotion and encourage healthy lifestyles.”

    Moreover, the panel says, the private medical care sector must come under some form of regulation.

    “The private medical care sector in Bermuda is largely unregulated, raising concerns about both the cost and quality of the care provided, of diagnostic testing and of pharmaceutical products,” the panel writes. “Further efforts are needed to strengthen the regulation of private sector providers (including their use of health technology) as a means to reduce duplication that adversely impacts healthcare costs and exposes patients to unnecessary risk. As in our 2017 report, we believe that an appropriate regulatory infrastructure with enforcement resources remains a necessary element of any strategy for cost containment in Bermuda’s healthcare sector.”

    http://www.royalgazette.com/business/article/20190128/healthcare-coming-under-strain


  • 28 Jan 2019 4:30 PM | Stephanie Lee (Administrator)

    Dear BMDA Members,

    At present, we are not aware that any of the  products on island are affected by the recall, but the pharmacy inspector, BGA and Pharmacy Council are continuing to explore the situation to confirm there is no risk. Once the risk assessment is complete, there will be an explanatory notice to the public.

    In the first instance and in the meantime, physicians should recommend that their patients contact the pharmacy that supplied the medication for specific information and advice. 

    When the Ministry receives medication recall information, we inform the hospital pharmacy manager, BGA and Pharmacy Council (who informs Pharmacy Association and pharmacies). When BGA receives recall information (which includes batch/lot numbers and expiration dates) they inform the pharmacies with instructions as to what to do with any affected product.  I have been informed that most of the ACE/ARB medications used on the island are imported from the UK and not the US which is where all  of the recalls have originated.  It appears that the European product has not been affected. 

    We will inform the community more fully when facts are confirmed.

    Cheryl Peek-Ball, MD, MPH

    Chief Medical Officer


  • 28 Jan 2019 8:00 AM | Stephanie Lee (Administrator)

    Duncan Hall (Published Jan 28, 2019 at 8:00 am (Updated Jan 28, 2019 at 8:21 am)

    Costly care: the Bermuda Government is planning reform of heathcare financing

    Costly care: the Bermuda Government is planning reform of heathcare financing

    By April, Government is expected to announce its plans for reforming the way that healthcare is financed in Bermuda.

    The Health Financing Reform Steering Committee has, since June of last year, been consulting with stakeholder bodies about two financing options. The committee has been tasked with delivering a programme that provides affordable and sustainable healthcare for all Bermuda residents.

    Kim Wilson, the health minister, last year said that the cost of the island’s minimum health package was shared across 48,000 insured people in Bermuda. However, supplementary benefits are shared across much smaller groups, leading to greater healthcare costs for treatment covered thereunder.

    By expanding the proportion of healthcare that is protected by the larger risk pool, she said, healthcare costs can be stabilised. Under the reforms, she said, the cost of healthcare “will be better than what most people pay for this level of coverage today”.

    Referring to medical care inflation of about 6.4 per cent in Bermuda, Ms Wilson said: “There were no fee increases and only negligible benefit changes. So the only reason the premium for the minimum package increased is because our people are sicker, older and receiving more healthcare.”

    The island’s Fiscal Responsibility Panel observed: “Regardless of which of the two financing proposals is adopted, Bermuda’s healthcare system needs to address: how to ensure any government subsidies are used most productively and fairly directed; how to ensure resources for healthcare in the economy are used effectively and with effective control of costs; and how to ensure that healthcare is at least accessible to all Bermuda’s citizenry.”

    According to the report, Bermuda’s Population Projections, 2016-2026, released last year:

    • Average household spending on healthcare was $7,000 in 2004, a 156 per cent increase on the amount spent in 1993 that was well in excess of the 32 per cent rate of inflation for the same period.
    • By 2013, the amount each household spent on healthcare was roughly $10,300, a 47 per cent increase on 2004. The rate of inflation during the same period was 30 per cent.
    • In 2013, households headed by seniors spent $10,919 per year on healthcare, up from $6,000 in 2004. Some 76 per cent of that expenditure was comprised of health insurance.

    According to the 2018 National Health Accounts Report, released last week by the Bermuda Health Council, the total public and private expenditure neared $723 million for the fiscal year 2016-17. That was a dramatic increase on the total expenditure of $460 million for the fiscal year 2006-07.

    http://www.royalgazette.com/business/article/20190128/healthcare-financing-reform-on-way


Powered by Wild Apricot Membership Software