In this year’s Throne Speech, the Government of Bermuda has reaffirmed its intention to implement universal health coverage for all residents.
Our vision for healthcare seeks to ensure that -
“all people have equitable access to needed informative, preventive, curative, rehabilitative and palliative essential health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services and critical medicines.”
Bermuda is fortunate in that we have a health system that is well-developed and well-supported by dedicated professionals. However, the overall affordability and sustainability of our health system is deeply concerning for this Government. Bermuda has one of the highest per capita health expenditures globally, but our population health outcomes do not reflect this.
Continuing with the status quo in the hope this situation resolves itself is not a responsible option.
Change is required, and the journey is indeed complex and one which we will travel together for several years as we seek to ensure –
·better health outcomes, particularly of chronic disease management,
·essential health services residents can be confident they can afford when they need them, and,
·the elimination of waste and duplication where it occurs.
Having committed to universal health coverage (UHC), the Ministry of Health was tasked with developing the way forward. To do so, the Ministry brought together acore group of stakeholders from across our health system to serve as the UHC Steering Committee to develop the roadmap for strengthening Bermuda’s healthcare.
The UHC Steering Committee is led by the Ministry of Health and comprises representatives of Bermuda First, the Bermuda Medical Doctors Association, Bermuda Health Council, Department of Health, Bermuda Hospitals Board, the Health Insurance Department, Ministry of Finance and a Patient Representative, and its work is supported by KPMG.
In this process, the Steering Committee took note of healthcare systems in other jurisdictions, large and small, who have already taken their first steps on this journey. It is clear there are many paths to reach universal health coverage – and it is advocated by the United Nations and World Health Organisation – but the approach taken here, on our island, must be Bermuda-centric.
Examining our health system, the UHC Steering Committee identified a number of actions to prioritise for its strengthening. These can be grouped into the following three areas:
1. stewardship and governance,
2. healthcare service delivery, and,
3. health system value and financing.
Stewardship and governance is the foundational framework for the health system. This is where vision and strategy are set, population health needs are understood, transparent responsibility and accountability are established, and organisational and legal structures are implemented.
For example, with respect to transparent responsibility and accountability, identified actions include setting standard metrics for measuring and monitoring system and population health performance and public reporting of the results. How does Bermuda measure up against other jurisdictions in terms of our population’s health? How does Bermuda measure in terms of best practices?
Strengthening healthcare service delivery involves ensuring all residents have equitable access to essential healthcare integrated in an efficient manner and which produces good patient experiences and health outcomes.
Identified actions in this area include determining: What are the essential healthcare services? What approach do we take to the delivery of care services? How do we take advantage of advancements in information systems to better manage patient care?
Concerning health system value and financing, this is a very challenging aspect for Bermuda. As stated previously, our health expenditure is high and does not match our health outcomes. However, before making abrupt changes to achieve a sustainable health system, it is crucial to fully understand current and future costs both at a system and individual patient level.
Therefore, identified actions include, but are not limited to: confirming current baseline costs; modelling future costs, as well as the sustainability of the ‘make no changes’ option; identifying saving opportunities across the health system; and, establishing a process to map baseline patient costs and model essential health care benefits.
While the pandemic delayed work on plans for universal health coverage as the Ministry, hospital, Health Council, physicians and allied professionals across Bermuda joined in the fight against COVID-19, this delay created space and time for the Ministry, working closely with the UHC Steering Committee, to develop a refreshed approach to health system change.
As a result, the many actions identified as necessary to strengthen Bermuda’s health system are based on, and framed by, a patient-focused approach that places patient experiences and outcomes at the centre of the work on universal health coverage.
Year 1 of the initial three-year roadmap for universal health coverage is foundational in nature. Three of the Year 1 areas of work are mentioned in the Throne Speech.
§ Digital health strategy – Establishing a national strategy for digital healthcare and data that leverages health information systems to harness improvements and efficiencies for patients, healthcare providers and health system payors.
§ Integrated patient pathway for essential care – Implementing a ‘patient-pathway’ approach, which focuses on a patient’s journey or pathway through the healthcare system, allows us to examine the fragmented components of healthcare and the costs involved at each point that care is delivered. A pathway can be a particular patient group (such as maternal-child care) or disease (such as kidney disease or heart disease). By following a pathway from start to finish, we can better see opportunities to improve patient experiences and outcomes, and address any duplicative, wasteful use of resources.
§ Commence merging of administration of Government healthcare plans – Review and implement a merger of the administrative functions of the government plans. A portion of this work was undertaken when the Health Insurance Plan and FutureCare were consolidated under the Health Insurance Department. This administrative merger would represent the completion of this process and involves GEHI and funds controlled by Financial Assistance and other patient care subsidies.
The other areas of work in Year 1 involve:
o setting up the organisational structure for stewardship and governance (including new working groups for collaboration with stakeholders),
o determining the baselines required, for example, for our health needs and for the metrics to measure our performance, and,
o establishing the economic case for strengthening our health system.
Vitally important for the work on universal health coverage is the engagement of, and collaboration with, the broad group of stakeholders who form part of Bermuda’s health system. There are many questions to answer and decisions to make that will need broader input than is represented solely by the UHC Steering Committee or the Ministry itself.
In the coming weeks, the Ministry will be meeting with the executive and membership of those represented on the Steering Committee, as well as the private insurers, Bermuda Medical Council and Nursing and Midwifery Council, the Bermuda Chamber of Commerce, Bermuda Employers Council, ABIR, ABIC, our union leaders and others. The purpose is to share the roadmap for achieving universal health coverage and the work done so far, and, most importantly, the work still to be done. We know their insight and feedback will be invaluable as we improve healthcare access, experience and outcomes for all who live here.
Finally, I would like to take this opportunity to thank the UHC Steering Committee for their hard work to date. This is the beginning of a multi-year journey with challenges and complexity in front of us. I very much appreciate your contributions, which have put Bermuda on a realistic path to achieve universal health coverage.