Bermuda Health Plan 2020

27 September, 2019

Mr. Speaker and Honourable Members,

Healthcare is surprisingly controversial.  

You would think the wish to give people care when they are at their weakest would be totally acceptable. And who would challenge the desire to get rid of inefficiency and duplication in an ageing, expensive health system?

Mr. Speaker, I accepted the honour of leading the Ministry of Health because I believe that despite detractors and despite disagreement on details, at the end of the day Bermudians want to take care of one another.

I believe this, Mr. Speaker. And I have every confidence the Honourable Members on the other side of this House agree with this as well.

We have seen our US neighbours to the West struggle with healthcare debates for decades. We have seen them struggle to achieve reforms that would put them on par with the rest of the developed world.

However, our own debates do not need to fall trap to the same debacle, Mr. Speaker. I believe we can chart our own path.

We can look to the best, the fairest and the most efficient health systems in the world and seek inspiration from them. We can learn from their achievements and apply the best methods here in Bermuda. We do not need to be held back by the resistance or, as seen in the US, a culture’s lack of support for health as a human right.

No, Mr. Speaker. With the mandate this Government received from the people of Bermuda, I know Bermuda believes that health is a fundamental human right and that everyone should have access to healthcare.

Mr. Speaker, I am delighted to rise today to speak to this Honourable House about the Government’s health financing reforms. As you know, we have begun a period of public consultation, during which we are speaking to stakeholders and the public on how we can ensure all of Bermuda’s residents can have affordable access to healthcare.

Some have asked, “Why are you doing this?” And the answer is simple: I want to make sure everyone can be healthier. From children, to adults and seniors, everyone can lift and elevate their state of health from what it is today.

This is not to say that I will prevent the ageing of our population or reverse chronic diseases overnight, or eliminate the socio-economic disparities that determine most health outcomes. We can’t do any of those things. But we can help everyone achieve a better state of health.

To do this we need:

  • More prevention
  • Access to healthcare for all, and  
  • A decent basic plan with benefits to keep us healthy

Mr. Speaker, to be clear, health coverage will not fix all of our health problems. But without it, we cannot fix any of our problems.

This is why ensuring health coverage of a decent package that is affordable and available to all is fundamental. And to do this, we have to change the way we pay for healthcare.

This is part of the broader goal to make Bermuda healthier through prevention and healthy living, because a decent package must include prevention, screening and disease management.

Mr. Speaker, to be clear, our health system has some exemplary strengths, but also some challenges.

  • We are the 3rd most expensive health system but rank 13th in life expectancy.
  • Health costs consume 11.5% of GDP
  • 75% of adults are overweight or obese
  • 54% of adults have one to two chronic disease risk factors
  • 12% of adults have diabetes, and
  • 10% of all our health spending ($78 million) is on just 2 preventable conditions (chronic kidney disease and diabetes).

Our system needs to change direction to combat this reality. We need systemic changes to incentivize good health behaviours and better health outcomes. This means reforming the basic insurance plan, and the way we pay for it.

Mr. Speaker, following extensive considerations, the Government has decided to adopt a unified model of health financing – that is, a single payer system – for the basic insurance plan.

This decision was taken with careful consideration of the health financing reform options developed by the National Health Plan Finance and Reimbursement Task Group in 2010.

Mr. Speaker, as I said in this Honourable House on July 6th last year, the Task Group that produced the options report included representation of physicians, insurers, employers and international business, and relied on the expert advice of the late Dr. Marc Roberts, Professor of Health Economics at the Harvard School of Public Health and imminent World Bank advisor and global health systems expert. The task group also benefitted from independent actuarial advice.

Mr. Speaker, while the 2012 modelling on benefit proposals is clearly outdated now, the options on how to finance the health system are not.  Global health financing systems have not changed and the work of this Task Group remains as relevant today as it was then – except now it is more urgent.

For this reason, Mr. Speaker, when this Government came to power, we decided not to waste time re-inventing wheels and we picked up the work of this bipartisan Task Group to decide how to achieve healthcare access for all.

I established a Stakeholder Consultation Group to review the options report and advise us of their sectors’ position with respect to the two options.  Then Cabinet considered their feedback together with our own fiscal goals and moral compass and decided that the unified model is best suited to achieve efficiencies, economies of scale and cost savings, given Bermuda’s small size.

Mr. Speaker, with the matter of which financing model to adopt settled, we are now moving on to the next phase and consulting on two specific questions:

  1. What the new basic insurance plan should include and cost (which will replace SHB)
  2. What we need to do to transition to a unified health financing system (a Roadmap)

The proposed reforms aim to create a sustainable platform for a patient centered care model to improve health outcomes. The Bermuda Health Plan 2020 has kicked off discussion with a “mock plan” for discussion purposes. The input of health professionals, insurers, employers, unions and the public will determine the final content of the basic plan.

Mr. Speaker, I want to stress that the public consultation is four months during which working groups will be established so that dialogue and collaboration with key stakeholders can continue beyond November and throughout the reform process.

The point to stress is that this is the beginning of the journey, with a goal to develop a transition plan and begin a phased implementation in Autumn 2020.

This is a seismic change, Mr. Speaker, and we don’t intend to do it overnight or in isolation. That is why we are consulting publicly.

A website has been set up to share information with interested parties and I have been meeting privately with stakeholders in anticipation of the public town halls that began on Monday 16th.

So, as I said in my opening, Mr. Speaker, health can be controversial – but only if we want it to be. If we believe that everyone should have access to healthcare, that every child deserves an equal start in life, and every senior an affordable health plan, then we are all on the same side.

Ultimately, Mr. Speaker, this is about making Bermuda healthier. And now is the time to drive this goal forward.

Thank you Mr. Speaker.