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Measures to make Bermuda's Health System sustainable

Monday, November 14, 2016

BY THE HONOURABLE JEANNE J. ATHERDEN, CA, CPA, JP, MP

MINISTER OF HEALTH AND SENIORS ON MEASURES TO MAKE BERMUDA’S HEALTH SYSTEM SUSTAINABLE

14th November 2016

 

Mr Speaker and honourable members,

I stand before this honourable House to address my fellow Parliamentarians and Bermuda on the critical matter of reducing health costs for the benefit of all residents without compromising the quality of care.

Mr Speaker, every adult resident of our Island is aware of our high health costs.  For a significant cohort of our population every month there is a struggle to make money stretch; ongoing co-payments are a challenge, and deciding which illness to treat is a tough decision.  The Bermuda Health Strategy and the Action Plan 2014-19 launched in January of this year, identified a range of actions that are now underway to reduce costs, and improve quality and access to healthcare.

One action, Mr Speaker, is the regulation of healthcare businesses. I intend to table the ‘patient safety law’ (formally titled the Bermuda Health Council Amendment Bill 2016), which will provide measures to enhance quality and oversight of healthcare facilities while ensuring costs are fair by protecting the public from avoidable harms.  The law will do three things:

  1. Require facilities to have a license which shows they are offering credible health services
  2. Encourage necessary and appropriate care even when care delivery may be influenced by financial interests
  3. Protect the public from risks and exposure to potentially dangerous equipment 

Mr. Speaker, let me first set the context for understanding the patient safety laws.  In economic theory, a market that meets all necessary conditions for efficient resource allocation is an ideal market; in the ideal market there are commodities to be bought and sold for profit.  Most societies see healthcare not as a commodity to be sold for profit, but rather as a basic human right that should be accessible to all citizens.  Healthcare is not an ideal market in economic theory. It is very hard to be a prudent purchaser of care when you’re in the ICU, having a root canal, or having a cyst removed.

Mr. Speaker, in addition, competition is also not the same in the healthcare market.  Competition can encourage excess capacity and duplication of services, and thus it can lead to supplier-induced increases in demand.  The Institute of Medicine and PAHO quote that 20 - 40% of healthcare expenditures are unnecessary and wasteful.  In healthcare, some health services are natural monopolies, which can lead to poor quality if competition is introduced.

Mr Speaker, it is within this quality care context that our unique healthcare market needs to apply oversight in competition that I will table the patient safety law.

In addressing the need to make the health system sustainable, it is recognized that the Bermuda Hospitals Board (BHB) has to be part of the solution in reducing health costs for the benefit of all residents without compromising the quality of care.

Indeed, BHB has implemented its modernization plan and made $40 million in cost reductions through efficiencies. This is despite increased demand on its services as our population ages, and the prevalence of preventable, and costly, chronic non-communicable diseases.

However, more is needed and my Ministry continues to look for ways to reduce healthcare expenditures centred in the hospital. We remain aware that BHB has legislated mandates that no other providers have - they must run 24/7, they are a national safety net and do not ever turn people away based on ability to pay, and they must always be prepared for disaster responses, such as ebola and natural disasters. But I firmly believe more can be done and I have tasked the Health Council with examining how to right size hospital fees for diagnostic imaging, laboratory services and professional services according to international benchmarks and industry norms.    

Mr Speaker, let’s be clear that this is not only about the hospital.  BHB has already voluntarily introduced guidelines to reduce unnecessary testing and increase governance, which has seen decline in its lab and Diagnostic Imaging modalities.  But they cannot stop misuse of the emergency department because ordinary working people cannot find after hours care or cannot afford co-pays, as they never turn anyone away.  The patient safety law will help to guide patients to the right care at the right time with information accessible to the public.  Further, these laws will protect the public from risks and exposure to potentially dangerous equipment while enabling tighter controls to ensure tests are medically necessary and clinically appropriate. 

Mr Speaker, while this will not be an easy road, we know that it will lead to better quality, better access and better outcomes.  To prepare, the Health Council has piloted licensing programs; consulted with internal, external, and international subject matter experts; conducted voluntary pre-registration of health service providers; and initiated a patient safety campaign to educate our residents about the importance of ensuring quality care with active participation in keeping costs fair. 

Mr. Speaker, this process of developing a patient safety law began in 2007 and it has taken ten years to reach this point.  It is a process that upholds the integrity of our facilities in maintaining first-rate care.  Our health system and the public’s safety are too important to leave to chance.  I believe that the passing of this patient safety law is the right thing to do now.  We can achieve quality, fair costs, and promote the right amount of competition in this unique healthcare market without compromising the safety of our residents – quality, safe care is a right we all deserve.  

 

Thank you, Mr Speaker.

 

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