Health Plan Consultation Q&A

This page provides the questions and comments submitted to the healthplan inbox and other official sources during the four month consultation from 9th August to 8th December 2019.

Submissions are included verbatim, anonymously, together with responses to each.

The purpose of this page is to provide factual information to the public and dispel misinformation circulating on social media.

Questions are listed first, with the most recent ones at the top. Comments are listed at the bottom.

 

QUESTIONS & ANSWERS

Q57) It is clear that costing of the proposal has been done back office. Why are the calculations not made public ?

A: The modelling assumptions are published here: https://docs.google.com/spreadsheets/d/1OQSpfno8vu01mZw0RUYz5K4DV7FArD3pcto0QjaLMEA/edit#gid=0

Q56) How is this plan helping anyone?

A: The Bermuda Health Plan proposes to build on the current system by improving the core mandated coverage, which currently is mainly local hospitalization. By grouping the core benefits into a large risk pool businesses will experience less fluctuation in their loss ratios and annual premium adjustments.

Q55(i)Do we want to be like the NHS in UK?!  Even they aren’t happy.

A: The model proposed by the reforms is not like the NHS. Rather it is a combination of private and public sectors.

Q55(ii) Why is Government not looking at why individuals are not paying their premiums? If they can’t afford them now they won’t be able to afford them in the future.

A: People are uninsured for a range of reasons which are documented in the 2016 Census. To ensure the country’s $723 million annual health spending can suffice for all the population, it has to be allocated differently. Hence the financing reforms to ensure subsidies reach the people with the financial need.

Q55(iii) Government needs to address the root problems of bad health eg diabetes, obesity, lack of exercise.  Why not invest in addressing these problems and cover more with present insurance premiums eg preventive care? Costs are much higher after one becomes ill especially terminally ill.

A: We agree completely and this is exactly what the reforms propose: to add preventive benefits to the existing mandated core plan. By adding benefits that will help people with chronic conditions we can ensure they don’t have expensive complications or need more complex and costly healthcare.

Q54) Shouldn't health insurance coverage for disabled under age 65 be similar to Futurecare to include some prescription drug coverage etc.?

A: Yes, we agree wholeheartedly. The reforms seek to offer better coverage including prescriptions to people under 65 including those with disabilities.

Q53(i) I am also missing the information regarding supplemental benefits to be bought from private insurers. How easily could they renounce/cancel my private insurance?

A: Currently insurers are not obligated to accept any person on their plans. For example, a person aged over 75 is not permitted on private insurance plans. On hearing the public feedback, the government is concerned about the risk in a reformed system and this will be considered following the public consultation.

Q53(ii) Why not team up with an international insurance company like BUPA for the whole of Bermuda and spread the risk wider? 

A: The intent is to keep the healthcare dollars locally. However, others have also proposed including overseas providers in any procurement for the administrator. This will be considered by working groups after the public consultation.

Q52(i) Our health insurance is very important and as a parent with a Type 1 diabetic child recently diagnosed that has to go off the island twice a year how will this work on a government plan that doesn’t cover what we currently have and how much will a supplement plan cost that the insurance companies of this island are not on board with. 

A: Your current insurance plan includes, by law, a mandated core plan. It’s called the standard health benefit. It doesn’t include overseas care. The intent of the reforms is to include medically necessary care in the core plan. So your supplemental can be less.

Q51) Why is the Government frightened of extending the consultation deadline? 

A: The four month public consultation period has given good time for all stakeholders to become engaged. Consultation will continue with stakeholders in working groups.

Q50(i) GEHI is already ineffective and isn't run well, how can you assure us that your new system will run better? 

A: The intent is for the administration of the plan to be outsourced, for example, to a quango or a private company. 

Q50(ii) What will happen to the people who can ill afford health care even if their income is too high to receive benefits from the government? 

A: Over time, the intent is to restructure patient subsidies so that rather than being age-based as they are now, they may be directed at those with greatest financial need to subsidize their premiums.

Q50(iii) Why not have a system like the NHS to serve people who can't afford health care and charge us a tax? 

A: This option was considered and it was determined that the Bermuda community would not be accepting of an NHS model. A single payer uses a public and private partnership. 

Q49) If your plan does get enacted, how many more civil servants will be added to an already bloated CS?

A: In answer to your question, as the administration will likely be outsourced to the private sector, it will not be operated by civil servants.

Q48(i) First of all, how does the Bermuda Health Plan lower health cost for a person who is currently paying for major health coverage?

A: $355 of your major medical is the current ‘core plan’ (now called the standard health benefit). This groups all of Bermuda together already in a virtual pool that is community rated. The more benefits there are in the large risk pool, the less volatility there will be for smaller groups.

Q48(ii) If currently everyone who is medically covered has to pay the core plan legislated by the govt., will the new plan be adequate to not need supplemental health care?

A: The goal is for the core plan to grow, over time, to provide a solid set of essential services so that everyone can have what they need. Some will still want more coverage, lower co-pays, more overseas choice and so on. Those extras would be available through supplemental coverage.

Q48(iii) If we currently say there are too many uninsured or underinsured, how will this plan resolve this problem?  If people are unable to pay the lower costs now how will they pay the increased cost?

A: It will take 3 – 5 years to gradually bring everyone into the large pool. To do so, the existing patient subsidies will be restructured so that instead of being purely age-based, they are directed to those with financial need.

Q48(iv) Under the Bermuda health plan, with a unified approach, how will it provide better healthcare?  Looking at many of my friends and family in Canada, they have difficulties getting appointments and treatments due to the the many patients.  Will this new health plan cause similar issues in Bermuda?

A: The goal is to ensure everyone can have access to timely essential care. Competition with private provision will be allowed, so people would be able to access care outside the core plan to reduce their wait time if desired.

Q48(v) Why can’t the government legislate a pricing scheme to allow for better rates by the physicians?

A: Some already are – namely, private doctors and dentists procedures done in the hospital. It’s called the “Medical and Dental Charges Order”. Legislating fees for all services would not have support of the medical community. The intent, instead, is to legislate the fees for services that are in the core plan.

Q47(i) Does the BHP cover private psychology/psychiatry sessions or only MWI? How many sessions? We should strive to have mental health resources as widely available as possible, as a population that is happy and mentally-stable will be better able to take care of themselves physically.

A: The “mock plan” only includes MWI. However, feedback to date has indicated a desire for more community based coverage. This will be considered by working groups following the public consultation.

Q47(ii) I note that allied health services are not included in the BHP. I would urge you to include them in any subsequent revisions. They are a required complementary service to many medical treatments.

A: Yes, others have also suggested this and it will be considered.

Q47(iii) Is there consideration in allowing trained nursing staff to do more procedures than they are currently allowed in Bermuda? For instance, in the UK many nurses/midwives deliver babies without doctors. Additionally, nurses triage patients extensively without doctors in the UK. This may cut down considerably on hospital costs.

A: Absolutely and we have heard this feedback from others. The goal is to ensure persons receive the right care in the right setting at the right time, which means broadening the professionals who play a part in primary care and prevention.

Q46(i) I was wondering if there will be more public consultations now that more of the public is aware of this and interested in attending.

A: The 4 month public consultation period ends on 8 December. You can find the record of consultation meetings held: http://www.bhec.bm/bermuda-health-plan-2020-consultation/ 

Public dialogue will continue as working groups are established to digest the public feedback and recommend next steps.

Q46(ii) Will there be a plan to include alternative healing methods such as reiki and others in the new health plan so that people can claim on those services as well as the regular medical services. Reiki for example is being used more in hospitals overseas finally and wondering if the hospital would also consider hiring staff members for these types of methods of healing. There are advantages and benefits for pre and post opp as well as for staff and all patients with any ailments really.

A: The “mock plan” for consultation didn’t include allied health or alternative medicine. These can be considered following the public consultation.

Q45) Will GEHI be abolished and now form part of the Bermuda Health Plan? 

A: GEHI will not be abolished. It will be administered by the unified insurer.

Q44(i) [Personal and family medical information redacted] Please provide a breakdown of how this new scheme will be integrated with my current health care premiums.  Ie will I be paying the current $ 4200.00 plus the new Govt premium of $2000.00 plus for family coverage?  

A: No, you will not pay $4.2k + $2k. Currently of your $4200 monthly $710 is the standard health benefit (SHB, the current core, mandated package which is largely local hospitalization) for you and your husband ($355 each). Your children's SHB is paid by the government and free to you. The remainder of your $4.2k premium is for supplemental benefits. When a new SHB/core plan includes more benefits, they will be deducted from your supplemental benefits. Legally a person cannot be insured twice for the same benefit. Therefore, the more coverage is in the core plan shared with a large risk pool of the whole Bermuda population, the less volatility there will be in that coverage for you, and the less supplemental coverage you will need. The “mock plan” in consultation is $514 for each adult and $178 for each child. The final core plan will be determined after the consultation feedback is compiled and reviewed.

Q44(ii) What will change with my coverage of [redacted specific drug], and all,current prescriptions, and how will this breakdown for remuneration? Ie will the new scheme cover a portion and the balance be reflected on my insurance?

A: Correct. If prescriptions are included, the core plan will be the first payor up to the covered amount, and your supplemental insurance would cover the balance. Currently the core plan does not cover medications.

Q44(iii) Will I be able to keep privatized insurance?   At what cost?

A: Yes, private insurance will cover supplemental benefits. The cost depends on the risk an individual presents to the insurer, as it is currently. But with more of your chronic conditions covered under the core plan, your risk profile will be more favourable and should be beneficial to your premium.

The intent of the reforms is to gradually, over time, include more essential services coverage in the core plan. This will be especially helpful for persons with chronic conditions as being in a large risk pool will put you in a much better position that being individually risk rated as you are currently.

Q43(i) Will the proposed new healthcare plan ensure that all medical testing equipment (e.g. blood testing machines, MRI’s etc.) be owned only by the Bermuda Hospitals Board to ensure the profit from using such equipment is clawed back into the healthcare system for the benefit of the people and not for the private profit of doctors? 

A: Currently clinical lab coverage in the core plan (the standard health benefit) is only covered at BHB. There is no intention of changing this. SHB covers some imaging procedures are approved facilities only, in addition to BHB. The model will remain as it provides helpful capacity to the health system to avoid long wait times and ensure hospital equipment is available for acute care.

Q43(ii) Or to put it another way…for all persons under the proposed new healthcare plan, will they be directed to the Hospital for all medical testing to ensure it is the Hospital that profits from such use, rather than doctors who unfortunately are allowed to both run a medical practice and also own their own testing equipment which creates toxic conflicts of interest which drives up healthcare costs from over testing and unnecessary testing.

A: Conflicts of interest are addressed when a business or charity is approved as a provider of services in the core plan (SHB). This is to avoid financially vested referrals and will be continued under the reforms for any service in the core plan.

Q42(i) Who will be administering the new plan? 

A: The consultation will inform that final decision. At present the preference is that administration be outsourced to a private provider through a competitive procurement process. The decision won’t be made until the consultation feedback is collated.

Q42(ii) What company will you liaise with to cover overseas treatments?

A: The overseas administrator would be engaged through a competitive procurement process.

Q42(iii) Will it be managed overseas? 

A: Depends on the outcome of the procurement process.

Q42(iv) What tier of hospital overseas will be able to use?  If it is not a gold standard with the best care then it will not be acceptable.  

A: Locally there are no tiers and that would remain. Overseas the intent is for the plan to cover medically necessary care not available locally. Currently the core benefit plan within your insurance policy does not include any overseas coverage. All your overseas coverage is supplemental to the core plan.

Q42(v) How many people in Bermuda are NOT covered by private health care?   

A: The Ministry has always quoted a consistent figure from the 2016 Census report, per Table 1. [page 42]

Q41) Have you considered a Canadian current health system, a " universal health system " the poeple who work pay income tax or payroll tax that we pay to BERMUDA GOVERNMENT, there basically same terminology. The people of CANADA rather they work or not they still get treated at hospital For any type of medical conditions, they are covered and won't have to pay for it out of poket. Sell there house e.t.c. Health care who ever comes into hospital get treated., and is payed for by that government tax system, Thank you.

A: One of the aims of the Bermuda Health Plan is to transition Bermuda to a single payer system (or a unified financing model). This is similar to the Canadian model. The goal is to develop a sustainable platform to improve access to healthcare for all and control costs.

Q40(i) What does the current research say about the link between increased doctor visits and preventative care?  Just because a person sees a doctor more often doesn't mean they are going to be healthier - maybe an education campaign would be more benefital?

A: The purpose to giving access to primary care is so health can be monitored, and any problems can be identified and treated early on; and managed if they persist.

Primary Health Care focuses on people’s needs as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care. Research further notes that General Practice underpins population health outcomes and is key to ensuring a high-quality, equitable and sustainable health system into the future. We are not only looking to lower any barriers to accessing care earlier but also looking to build a better system of health promotion and education around it to support our health professionals in their provision of care and individuals in their daily living.

Q40(ii) Why does the proposed BHP only cover $400.00 ? Where did the figure of 400.00 come from ? What is the current average cost of prescriptions per adult and child ? 

A: The proposed BHP should be compared to the current $0 that is covered under Standard Health Benefit, and not the coverage that is currently covered under supplemental insurance. The $400 was put forward as a proposal for discussed based on our average pharmaceutical spend in Bermuda which is approximately $548 per person.

Q40(iii) Currently, a private plan pays 80% brand name drugs and oral contraceptives/injections and 100% of generic drugs, will this be the case on the new plan? What do the figures look like for abortions- both medically necessary and elective? Will they be covered under the plan?

A: The coverage of any drug plan will look to incentivize the use of generic drugs where appropriate.  A formulary or list of essential medicines would formalize those incentives through legislation.

Terminations of pregnancy are currently covered under Medical and Dental Charges Order legislation and will continue to be so.  Whether they would be covered by the core plan in the future would be determined at a later stage.

Q40(iv) Who determines whether or not a visit abroad is "medically necessary"?  If a person does have to travel, will they be given a stipend? What about a companion to travel with?

A: As is now, a physician works with the patient and the insurance company to determine whether options are available locally and whether it is defined as an elective or necessary procedure, and what supports are necessary.  That process would continue.

Q40(v) I love me doctor and the health care she provides me and my family.  I'm concerned she will leave Bermuda if she is not making enough to cover he insurance etc.  How much less will physicians be making? Is there a concern that physicians may want to leave Bermuda ? If many doctors leave, what is the plan to hire more?  Bermudians deserve the best - not sub-pare educated doctors who will come to work here for a lower wage.

A: As the physicians have noted, there is no intention to reduce revenue to primary care services. All proposals welcome physician feedback as no decisions have been made regarding benefits, fees or reimbursement.

Q40(vi) What exactly is covered with basic dental and vision?  Will prescription glasses be covered? At what amount?

A: Coverage for basic vision and dental are intended to be based on preventative care guidelines.  A survey of the population did indicate a preference to have basic dental and vision services as part of a re-designed SHB/core insurance package.  However, these services and the approach to ensuring access to them will be further discussed in working groups with oral and vision professionals. 

Q40(vii) Please provide a list of the basic coverage for the overseas care.

A: Services that are medically necessary and are not found on island is the guide.  Current insurers do not provide a defined list of services that are covered overseas now, rather the needs of patient and the ability of the local system to meet them are taken into account.

Q40(viii) If I have a preexisting condition  ie. Diabetes/high blood pressure will I receive the full benefits that I currently have?

A: Pre-existing exclusions are not allowed under legislated SHB coverage.  If a service is covered under the BHP, it will be regardless of if you have a pre-existing condition or not.

Q40(ix) Cost of living is already incredibly high in Bermuda, many people already can't afford HIP.  What is the plan for these people? How can the government afford to continue to subsidize them, especially at an increased price?

A: Currently the cost of subsidizing HIP clients is borne in two ways, by transferring costs to the rest of the population, or through out-of pocket payments from HIP clients.  For those who are not receiving adequate access to needed services in a timely manner, the rest of the population is having to pay for those delays in treatment.  Therefore the real cost is not in the premiums themselves but rather in the expensive complications and poor health outcomes we are achieving.  If we can get the sickest HIP clients, who on average cost 4x as much as everyone else, into better health, then the rest of the population would not have to take on so much of the burden of covering the costs of those who require assistance.

Q39) Even though health insurance is mandated by law . Those businesses that are not adhering to that and are also taking deductions of employees pay are being supported by the courts as to the ltd laws.  Check supreme Court. Appellant jurisdiction 2016: civil appeal no: 25 [redacted] Judgement. Also magistrate's court case same appellant and respondent. No money's awarded yet in either case. He just appeals and appeals. Knowing that my pockets to respond are shallow. Same for pension and social insurance. I've had to push Gov agencies to take him to court. I've done all that i can. Frustrated. The courts didn't even want to entertain my case even though I had loads of evidence including fraud. What can I do. Pension commission say that their waiting for him to declare bankruptcy even though they have a court judgement on him. What's that???? Please help me. 

A: From what you describe it seems your case is likely already an active case being handled by the Bermuda Health Council, who enforce employer’s compliance with the Health Insurance Act obligations. I believe they have been in touch with you already, but cc the person responsible for assurance. 

You may already be aware of this work but you can read more about it here: http://www.bhec.bm/employers-compliance/

Q38) Will the BHP still provide coverage for overseas care within network as is currently provided and air ambulance support?

A: Currently the mandated basic plan, the standard health benefit, doesn’t include any overseas cover. The intent of the reforms is to include medically necessary care not available on island, inclusive of air ambulance. The final coverage recommendations will be made following consideration of the public consultation feedback and fulsome actuarial analysis.

Q37(i) I have looked through the various publications but can’t see the actuarial analysis/ consultation that drove the new estimated price pp pm for the national health plan.  Or a summary of it? Pls can this information be shares publicly? This is the info that people need to see to in order to have faith that the system is being correctly priced up.

A: The mock plan modelling assumptions are online via the Consultation Guide link. You can find them here: https://docs.google.com/spreadsheets/d/1OQSpfno8vu01mZw0RUYz5K4DV7FArD3pcto0QjaLMEA/edit#gid=0

After the public consultation, working groups will review the feedback and make recommendations on what the plan should include. This will be accompanied by comprehensive actuarial analysis that will be published once completed, just as the current standard health benefit reviews are published annually: http://www.bhec.bm/actuarial-reports/

Q37(ii) When are the estimates going to come out about what will be expressly covered and how much a supplementary health insurance plan would cost?  This is the info that people need to see to buy into the initiative.

A: The intent is for working groups to review the public consultation feedback and make recommendations on what the plan should include. This should take approximately six months.

However, the intent is not to roll out a full new benefit plan in 2020. Rather, there will be a phased addition of benefits over several years as the plan is rolled out. The autumn 2020 beginning of the phased implementation could, for example, include addition of the most essential benefits to the current standard health benefit.

The impact to supplemental premiums will vary by group, as it does now. What the government will be able to share is the impact to government plans which have supplementary health insurance, as an example of impact on such benefits.

Q36) Will Chiropractor visits be covered under the proposed health plan? If so, how many visits per year?

A: The mock plan for consultation did not include chiropractic coverage or allied health services like physiotherapy, etc. However, the consultation process has highlighted omissions and these will be reviewed.

You can see the modelling assumptions and list of coverage in the discussion 'mock plan' here:

https://docs.google.com/spreadsheets/d/1OQSpfno8vu01mZw0RUYz5K4DV7FArD3pcto0QjaLMEA/edit#gid=0  

After the public consultation is over, working groups will review the feedback and determine recommendations on what the proposed plan should include.

Q35) My daughter has been treated for [redacted] since she was 2 years old for the last 8 years through her local pediatrician in conjunction with [overseas hospital redacted].  She currently goes for regular checkup visits every 6 months to her Rheumatologist and Ophthalmologist there.  She has been on medication the entire time and I am very concerned that she will not get enough coverage for her prescriptions as this is an ongoing condition.  She also has the potential to relapse and require emergency care overseas.  Will this be covered under the new plan?  What restrictions on care will she face under this proposed new plan? I look forward to any insight.

A: The “mock plan” that is part of the consultation discussion proposes to cover medically necessary care not available on island. From what you describe, this may well be the case with your daughter’s condition and treatment. As is the case currently, a medical referral would be required. We are also working with pediatricians with an interest in securing sound local coverage for all children.

Q34(i) Can you kindly confirm if there will remain some coverage for speech therapy,  occupational therapy and physio therapy???  At present BF&M and ARGUS provide $75 per session, and COLONIAL only $65.

A: The mock plan for consultation did not include allied health services like physiotherapy, etc. However, the consultation process has highlighted this omission and this will be revised. After the public consultation is over, working groups will review the feedback and determine recommendations on what the proposed plan should include. Allied health has be raised as an important item to consider.

Q34(ii) How will the proposed health changes affect the co-pay for clients receiving Speech, OT and PT?

A: All services in the BHP will have regulated fees and co-pays. The actual reimbursement will be set in collaboration with the relevant professions as part of the actuarial pricing. As a general rule, we have heard that co-pays in the $20 to $50 region are generally acceptable to a majority of the public (though not affordable by all). These matters will be considered by the working groups for a final recommendation. However, per the current standard health benefit, co-pays will be set by the plan.

Q34(iii) Realizing that resources from government have never been enough to fully service all of our people, many try to seek private Speech, OT and PT because of this, and are not able to afford it as it is. Will co-pay still be available and if so, what will the amount of coverage be?  Also, if coverage provided, will Speech, OT and PT be considered as one area (thus a child needing all 3 of these services can max out insurance benefits in merely a couple of weeks).

A: Our information concurs with what you describe. As stated above, the inclusion of allied health will be considered as a priority although it had not been in the mock plan, and co-pays for covered services will be set by the plan. Review of the feedback will consider how the coverage is structured in light of persons experience with maxing out.

Q34(iv) Thank you for your reply. Numerous families in Bermuda rely on their co-pay benefits in receiving allied health care. This HAS to be included.  Benefits HAVE to be provided, else the private sector of health care will fail.  The public sector can not support the services as it is.  This is a very dire situation and of grave concern.

Q33) A few weeks ago the Minister of Health was to hold a Town Hall Meeting at Bermuda College at 8:30 am. Unfortunately for the group of persons who showed up, there was no presentation.  At the time we were advised that it would be rescheduled.  Any idea if this will be scheduled prior to the consultation period finishing.

A: That town hall was being organized with the Chamber of Commerce and the Bermuda Employer’s Council for their members. The Chamber requested that we postpone it so members could attend the  Bloomberg presentation. As they had sent the invitation to their members, they advised that they would inform them of the cancellation. It has been rescheduled. You can reach out to either of the bodies if you are a member so you can register to attend.

Q32(i) How will the Government ensure each person pays into health care?

A: Full enrolment would have to take place over a 3 to 5 year period. Different mechanisms will have to be used for different populations to enforce what is known as the ‘individual mandate’. After the public consultation working groups will be established to develop a roadmap to implement the reforms over several years.

Q32(ii) What will happen to folks who cannot afford to pay into the system?

A: In the first instance we will continue to rely on the financial assistance process which already supports those who are eligible. Over time as the reforms are developed and phased in, existing subsidies will be reformed so that they are targeted to support the people with financial need rather than the current age-based model.

Q31(i) Firstly is it true that all civil servants on GEHI will continue to receive all their benefits for the same Premium that they are currently paying while the rest of us will have to buy supplementary insurance to Receive our same benefits?

A: No. This is not true. GEHI premiums are adjusted every year in the same way private premiums are and will be going forward. We modelled what the impact of the mock plan would be on GEHI and the projection is that there won’t be a negative impact. As GEHI is very similar in coverage to other comprehensive plans it is reasonable to expect a similar impact.

Q31(ii) Secondly, is it true that the Government coverage will not include anything for visits to dentists except a Basic exam and cleaning?   Anything further like cavities, teeth being pulled, braces, etc. will have to be Paid for out of pocket, also visits to eye doctors will just cover the exams and nothing extra like glasses, Cataract surgery etc.?

A: The current government-mandated coverage does not include any of the things you list. It only covers hospitalization and a few community based services like diagnostic imaging. The proposed reforms will add benefits to the mandated coverage, but it is not the intent to make it fully comprehensive. Unless the consultation feedback indicates that it should be.

Q31(iii) It is true that EVERY person will have to pay the Standard benefit, meaning a husband and wife with three children Will have to pay for five coverages at $500.00+ each – ie $2500.00+ each month?

A: Currently every persons pays the standard health benefit of $355.31. All children are paid for by the government. The mock plan has a premium of $514 for adults and $178 for children. But the final benefit plan will be determined based on public feedback.

Q31(iv) Will persons on GEHI not have to purchase supplemental insurance like the rest of us will.     Their premium now covers both the basic benefit and the supplemental?

A: Like all existing health insurance plans, GEHI currently includes the mandated plan (standard health benefit) plus supplemental benefits. As the reforms are rolled out, the same will continue to be the case. After the public consultation period, working groups will review the feedback to develop recommendations on what the core plan should include and how to transition to a new financing structure. How existing insurance policies will interact with the core plan will be part of that development in consultation with insurers and employers. Feedback to date has indicated disfavour with the prospect of paying two separate insurers. This important feedback will be considered as part of the consultation process.

Q31(v) Will children who do not now pay anything will have to pay $178.00 each in the future?

A: Children who currently pay nothing are only covered for hospital services. This will continue to be the case. The additional premium will be to cover additional services in the core plan.

Q30) As stated in the news today 31% of employers are behind in their social Insurance, to date we have not been told how far behind people are with their payroll tax, the last figure I heard was over 100 million. What force are you going to put behind people paying into The new health care reform? While companies that pay on time compete against others that don’t contribute, it is very worrisome as the pot of payers seems to be getting less and less. Help me to understand why when I like my stable insurance I should have to change in order to sustain people that don’t pay into the system?

A: In the current system $99 of your legally mandated monthly insurance goes to support low-cost plans and chronic diseases treatment for the broader population. It’s the way the health law has existed for decades as way of risk pooling. The proposed reforms build on the existing framework.

Bermuda already regulates employers who don’t comply with the law, and will continue to do so in future. You can see this work here: http://www.bhec.bm/employers-compliance/  

Q29) I am a senior who cannot afford even HIP/Futurecare at present.  When the Government says that the new scheme will be compulsory does that mean literally for everyone.  And if it does, then I want to know how I can finance it. It's unlikely that Financial Assistance would fund everyone who presently can't afford medical insurance as if it did then there wouldn't be so many of us who don't have insurance as no-one chooses to be without medical insurance if they can finance it either with their private funds or through Financial Assistance.

A: Thank you for your feedback. We are very sorry to hear of your circumstances and, indeed, regretful that you are not alone in this situation.

The aim of the reforms is to slowly, over time, extend coverage to everyone. Insurance subsidies will replace existing subsidies to ensure the funds available go to those whose financial means require it. This is why we have to reform the health system. To target the funds better so they reach persons like yourself.

Q28(i) No one seems to be taking about the regulation of the insurance companies who are increasing premiums annually and making millions of dollars in profits

A: The intent of the reforms is precisely to create affordable and sustainable health coverage. This will control premiums and will include adjustments in insurance regulation.

Q28(ii) Will the government changes look at the outdated hospital fee schedule?

A: The Government changed the hospital fees in 2018 to the internationally accepted standard of resource based relative values. The method of funding the hospital was also changed to a block grant model which promotes greater efficiencies.

Q28(iii) To me it appears that fees are heavily weighted to the very expensive hospital . Cheaper more cost effective community treatments are not reimbursed at a fair rate so it’s not viable to offer some of the services in the community

A: We agree that more cost effective community-based treatments must be covered and reimbursed at a fair rate. The Bermuda Health Plan is seeking to do just this by including more community services in the core plan. See: www.gov.bm/health-plan-package-design

Q28(iv) The insurance companies need to be held to account

A: Insurance companies are regulated and fully compliant. However, the reforms aim to create a more sustainable platform to provide coverage for everyone.

Q28(v) What level of cost control are you recommending regarding  over utilisation? GPs requesting specialist scans/ tests etc . People being sent away when the are good treatments available locally?

A: The Bermuda Health Plan aims to use best practice clinical guidelines to assure appropriate utilization. Overseas care will be covered only for medically necessary care not available on island.

Q28(vi) I agree that the under/ uninsured need to be looked after but this will be a wasted opportunity if the insurance companies are not regulated and modernised 

A: We agree that financing reform is needed to create a more efficient insurance market in Bermuda. We appreciate your feedback on this matter.

Q27(i) Have you considered the jobs you will take  away if you continue with this.  BERMUDIANS  will be out of work.  Single Mother's who are fighting to keep their ships going. Insurance companies will no longer need the bodies they have now. Are you going to help pay the bills and put food on the table?

A: The intent of the reforms is to create more affordable and sustainable health coverage. We seek to do this in partnership with insurers whose expertise in case management can continue to benefit Bermuda. A working group will develop a transition roadmap to slowly phase reforms and ensure smooth change over a number of years.

Q27(ii) You have not answered my question.  Bermudians that work for local insurance companies are going to lose their jobs starting next year.    Have you considered this and how do you propose to help.  So much for this government being for the people.

A: It’s not clear why you believe Bermudians will lose their jobs? Please share the evidence and data leading to your belief so we can respond to the facts.

Q27(iii) It is fact not fiction.  Reach out to the insurance companies and ask.  I know of one in particular that have already advised staff of job losses coming early 2020

A: As you know, the Health Plan will not result in any changes until later in 2020. An insurance company’s decisions for early 2020 cannot be related to reforms that have not happened.

The intent of the Bermuda Health Plan is to begin a phased implementation in autumn 2020. It will not be rushed. The first step may be something as simple as adding prescription drugs to the standard health benefit. The first steps and phased process will be determined by working groups who will digest the public consultation feedback.

Q26(i) I currently have my children under my work plan. How much will it cost?

A: The proposed Bermuda Health Plan includes care for children at a premium cost of $178 and $514 for adults. Currently, all children are covered by Government subsidy for basic insurance; and supplemental benefits are provided voluntarily under employer-based insurance benefits. Supplementary insurance coverage for children is not legally mandated, but most employers extend comprehensive benefits to dependents.

Q26(ii) How will this be done under the new plan? Will I need multiple policies?  Will all my claims go to a single point for processing. How will disputes on claims be handled?  How are employers going to provide same benefits plans. 

A: Currently your mandatory core plan is embedded within your insurance policy by law. The supplemental benefits are voluntary by each employer. Insurers collect the full premium and transfer most of the core plan to one fund. Going forward the core plan will slowly expand and its premium will be paid through your employer. Supplemental benefits will continue to be voluntary as they are now.

Q26(iii) How does this plan tackle health care costs?

A: The government chose the unified/single model as a more efficient, sustainable solution for Bermuda. The current health reforms seek to create an expanded core plan for all insured persons in order to address the inefficient risk pooling that currently exists. The expanded core plan for all insured persons aims to provide more preventive services to keep us healthy and to set fees and copays for covered benefits at fair rates.

Q26(iv) It appears that BHC is unable to adequately budget and manage cost of services and needs to find its debt.  How many staff will be required to manage this new system?

A: It is not clear who “BHC” is or what debt is referred to. If you clarify we can respond.

The details of how we transition to a unified model and who will administer the core plan will be determined by working groups following consultation. It could be done by the Government (as HIP and FutureCare are currently) or by a Quango, or outsourced to a private entity following an transparent competitive tender process. Part of the consultation is to hear feedback on which would be most appropriate for Bermuda. Further development of the roadmap for transition will answer this question more concretely.

Q26(v) Will govt have access to my health information? Where will this data be stored and who will be responsible for  its security?  Will I have be able to get a report on who has accessed my information?

A: Currently the hospital, a government body, manages the health records of its patients; each private and Government insurer manages the health claims records of its policy holders; and each Government and private healthcare provider manages its patient records. None of this will change.

Q25) Will the government create legislation to change healthcare after the public consultation?

A: No. After the public consultation working groups will be created to consider the feedback and plan next steps. No legislation.

Q24) Can you please tell me who the key stakeholders you used before deciding on the unified plan? Why didn’t government consult with all stakeholders and listen to all possible solutions to providing universal healthcare? 

A: The Government’s decision on the single payer option, or a unified health financing system, for a core benefits plan followed extensive considerations, documented in the published 100-page ‘Health Financing Structure Options Report’ at www.gov.bm/sites/default/files/Report-on-Financing-Structure-Options-2012.pdf. The options were developed by a bipartisan task force comprised of insurers, employers and healthcare providers, and the considerations are detailed in the report. Subsequently, in 2018 the Ministry of Health consulted on the options with key stakeholders which included healthcare providers, insurers, employers and patient advocates. The report of that consultation process is available at www.gov.bm/sites/default/files/HFR-Stakeholder-Consultation-Group-Report.pdf. Following these detailed considerations the government decided to adopt the unified model as the most efficient for our small jurisdiction.

Q23(i) I whole heartedly agree that Bermuda needs a new health care plan. It has become very difficult for many, including me, to pay for the being healthy. I have HIP, and many times I have to choose between bills, food or a Drs visit. I needed to see a specialist this summer, and it cost me $310.00, for a visit that resulted in no outcome for my issue. Disheartening to say the least. I can understand why many will chose to use the ER or Lamb-Foggo instead of their GP. I have done just that.

A: The experiences and issues that you highlight are exactly why we are consulting with the public on what coverage should be included and what price we’re able to pay. No one should have to choose between healthcare and other basic needs like paying a bill or buying groceries.

Q23(ii) I feel this new health plan needs to be very well thought out, with many, many discussions to come up with a viable solution to what we have today. And not rushed,  with a final date given of when it will start. That doesn’t work. All of Govt officials, on both sides of the aisle, need to be involved, with everyone knowing that we may not get what each side wants, but that we can compromise and hopefully come to an agreement.

A: The government wants to improve access and sustainability. We see patients, healthcare providers, insurers and employers as part of the solution. We can assure you that 2020 will not bring an overhaul of our health system or the way healthcare is practiced. The intent is to start with small steps, and stakeholders will help determine what they should be. After public consultation closes the development of the core benefit plan and the transition roadmap will be an iterative process with working groups comprised of the stakeholders that you mention. The launch date for the fall is the only the beginning of laying out a  transition plan for improving Bermuda’s healthcare system. We recognize that changes will not be realised at once but nonetheless, the areas of change identified by the working groups will progress on that date and extend out as far as they need in order to achieve our mission.

Q23(iii) These are the ideas I have: (coming from my having had HIP for the last 4 years)

•More mini “clinics” throughout the island. These could be run far cheaper (I believe) than a regular GP office, or the ER at KEMP. These would be for minor issues, and the ER left for true emergencies.

•There needs to be a cap on Drs fees.

•Meds need to be covered. Many times, meds are needed for preventative measures, and if you can’t afford meds, it will eventually put more financial strain on a Govt.

•Much lower co-pay at a Drs visit.

•Get rid of the “rule” of a consent form having to be filled out at a Drs office.

I had to have a routine colonoscopy, ordered through my oncologist. I had to go to the surgeons office, at a cost of $150.00, for a 5 minute visit, to sign a form giving my consent. This could have been done at the hospital. Obviously I gave my consent or I would not have called for the appointment. Not necessary, and a huge cost for a signature! That’s all I have.

A: These are very helpful ideas and thank you for taking the time to send them to us. We will consider your suggestions, many of which we are trying to address in the current reforms. The final benefit package is not decided yet and the public consultation period is providing valuable feedback on what people need, which will inform working groups that will make recommendations.

Q23(iv) After writing all that, I am actually leaving the island. I was fortunate to secure a green card, through my US born son, and I am moving back to the US. I cannot imagine being able to afford to live here in my old age, let alone today. It is too expensive. As much as I love my island, I am opting to leave, for many reasons, including a more affordable place to live, with more affordable healthcare.

A: While it is disappointing to hear that you will not be here to experience the benefit of our efforts to make healthcare more affordable, we also understand the reasons behind your decision. Your feedback has not gone unnoticed.

Q22(i) I have searched the web extensively  and haven’t been able to find any country like ours who have successfully moved from dual to unified?

A: Most countries who moved to unified did so decades ago and Bermuda is behind the times in improving efficiency in health financing. A good reference is “The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care” by TR Teid. https://www.kobo.com/us/en/ebook/the-healing-of-america-a-global-quest-for-better-cheaper-and-fairer-health-care

Q22(ii) I moved from Bahamas and saw Mr.Braithwaite refer to their plan incorrectly - it isn’t anything like what Bermuda is proposing! It is NOT a unified plan. Right now it’s not even covering 25% of their population and it’s also 100% voluntary?

A: The comparisons to the Bahamas are specifically referencing their primary care model as it relates to the primary care capitation model proposed in the Bermuda Health Plan.

Q22(iii) Can you kindly refer me to what other island or similar country does have a unified plan that is mandatory that has been successful in government functioning as the single payer.

A: No decisions have been made about who will administer the core plan. These details will be worked out in the development of a transition roadmap. In “The Healing of America” you will find useful examples. You can also find some recent developments in KPMG’s “Islands of Progress” https://home.kpmg/bs/en/home/insights/2018/12/islands-of-progress.html

Q22(iv) Could you also tell me when the public consultation was on the Unified as I could not find this anywhere on your websites?

A: Consultation took place in 2018. Find out more at https://www.gov.bm/health-financing-reform-governance. You will find consultation group report at: https://www.gov.bm/sites/default/files/HFR-Stakeholder-Consultation-Group-Report.pdf

Q22(v) I was told  only 4/14 Bermuda stakeholders  when consulted were IN FAVOR of the Unified so I am not understanding how we can even agree on a unified government function when we don’t have successful stories on your unification and LESS THAN 30% voted in favor?

A: Many stakeholders didn’t state a preference. The purpose of consultation is to assist the government in moving forward with an informed decision. The government chose the unified/single model as a more efficient, sustainable solution for Bermuda given our size.

Q22(vi) Why aren’t we  having a public consultation on the unified aspect when the favor ability is so low?  Mr. Butterfield’s group seemed to also have voiced concerned about your unified approach? I would prefer your answer rather than social media please. 

A: In this particular instance, consultation was targeted to key stakeholders representing the community. Stakeholders were given the opportunity to share the information and respond accordingly. The Government’s decision on the single payer option, or a unified health financing system, for a core benefits plan followed extensive considerations, documented in the Report on Health Financing Structure Options Report found at www.gov.bm/healthplan (link). The options were developed by a bipartisan task force comprised of insurers, employers and healthcare providers, and the considerations are contained in the published 100-page report. In 2018 the Ministry of Health consulted on the options with key stakeholders and the report of that consultation process is available at www.gov.bm/healthplan (link). Following these detailed considerations the government decided to adopt the unified model as the most efficient for our small jurisdiction.

Q21(i) When I asked about the single payer administrator, it was implied that there would need to have an incentive in order to get bids. So really the government is giving business to one entity so that they can make a profit. How is that any different than what we already have? Only, what we currently have provides us with a choice. Why is one payer better?

A: Any payor, whether private or public, needs robust administration. It has not been decided yet who would administer the BHP single pool. It could be done by the Government (as HIP and FutureCare are currently) or by a Quango, or outsourced to a private entity following an transparent competitive tender process. Part of the consultation is to hear feedback on which would be most appropriate for Bermuda. Further development of the roadmap for transition will answer this question more concretely. Ultimately, whoever administers the plan will have to be able to afford to pay the claims and associated business expenses, but the focus will be on efficiency not profit.

The proposed reforms are not limiting choice as there will still be a need for supplemental insurance. A unified payer removes the duplication and waste and allows for more money to be spent on prevention services.

Q21(ii) Financial assistance will be paying for the premiums for those persons who don’t have the resources to pay. Why isn’t that already happening? There has been concern to not segregate this group why haven’t they been included all along.

A: Financial Assistance does cover persons who don’t have the ability to pay by providing HIP or FutureCare for them. They are a much more disabled, older and sicker population. Accordingly, they are already included in the SHB/SHP insurance pool currently.

Q21(iii) Have the insurance companies been asked to redefine/restructure their basic coverage to include, what the government is considering, preventative services at a rate closer to the cost of providing care to lower the cost to the patient for the uninsured portion?

A: Doing so would be essentially keeping the status quo with additional benefits, or adopting the “dual model” which was considered as a health financing option. The government chose the unified/single model as a more efficient, sustainable solution for Bermuda given our size. A unified system will pool the insured population, not just the uninsured, but all insured persons will experience the benefit of a shared risk pool for the core plan.

Q20) Can you please clarify if the future care cost will be a combined cost (e.g $514 BHP + $500.14 Future care) or JUST the $514 if the senior needed the $2400 vs $400 RX. My inlaws found the Q&A answers on site useful with reference to their prescriptions being maintained- but were unclear of the actual cost to them.

A: FutureCare premiums are adjusted annually based on actuarial analysis. However, the intent of the proposals is to not impact FutureCare negatively. In the scenario proposed with the mock plan, FutureCare would remain at the $500.14; but the annual actuarial review has to be done before the next premium can be determined. FutureCare $2,000 prescription cover will not be reduced. The Bermuda Health Plan proposal for $400 per annum prescription coverage means FutureCare will either stay at $2,000 or it could be increased up to $2,400. The health reforms will pool all insured persons into one risk pool for the proposed core plan so plans like FutureCare should have a positive premium impact. It is difficult to provide exact numbers because no decisions have been made yet about the core plan.

Q19(i) I'd like to voice my concern with the upcoming mandatory health plan. On the plan I see it says $400 for prescription medications per year. I'm really worried about the sick in our society, the transplant patients, the chronically ill, the diabetics, the elderly etc. This simply is no where near enough to meet their needs.

A: The feedback that we’ve heard so far has overwhelmingly reported that $400 per annum prescription coverage is not enough. The $400 is for discussion and was based on the average spend on prescriptions per insured person. This has been important feedback and the final coverage will be revised for the final package. The proposed “mock plan” also includes a special programme for chronic non-communicable diseases which includes all prescription drugs. It’s called the “enhanced care programme”, and is designed to provide that additional treatment chronically ill persons need. The consultation feedback will be collated and together with a working group and actuarial modelling we hope a better level of coverage that remains affordable will be produced. 

Q19(ii) I can see so many ill people getting into serious debt and maybe even become bankrupt from this plan and that's only taking into account prescription medication coverage, what about when they have to go into the hospital for long durations? Or what about the surgeries they need? I really think this plan needs to be thought over and it needs to be done up with sick people in mind. What does it say about us as a society if we allow this to happen to our most vulnerable? I hope you take these concerns into mind when you work on this plan further.

A: The Bermuda Health Plan proposes to cover hospital care and medically necessary surgeries. The health reforms would improve waste and inefficiencies in our health system as well as provide a better core plan to keep us healthy. We agree with your concern that people should be protected and have access to care when they need it, and we have the public’s best interests in mind with the proposals for discussion. We’ve posted our answers to the queries and comments we’ve received to date at https://www.gov.bm/health-plan-consultation-qa.

Q18(i) I saw specialists this year inside of KEMH as an outpatient (neurology, internist) and did not have to pay a copay. But when I saw specialists at a doctors office, I did have to pay a copay. Will the KEMH hospital specialists count towards my allotment of specialists?

A: The reforms don’t introduce KEMH co-pays for specialists, so your existing hospital-based cover will remain as it is currently.

Q18(ii) What will happen to GEHI coverage - will there be the option to purchase supplemental coverage through GEHI or an external provider? The proposed plan is more expensive than the current GEHI premium with far less coverage.

A: GEHI benefits will remain the same but it will be enhanced by the Bermuda Health Plan (BHP). The BHP will expand and replace the Standard Health Benefit (SHB). SHB is required by law to be in every insurance policy but it primarily provides for care in hospital and lacks the prevention services to keep us healthy. The BHP will enhance GEHI because the proposed core plan will be spread across the entire insured population in Bermuda as opposed to just GEHI policy holders.

Q18(iii) I have a senior parent that is retired with GEHI insurance coverage. Understandably, this is concerning as a senior they are on a fixed pension income with a potential rising cost and significantly decreased benefits. Will they be restricted to the basic coverage of $400/year for prescriptions? Or will it be more aligned to Futurecare of $2000/year? Or will it be something else?

A: GEHI benefits will not be reduced by the reforms – they will remain the same or be enhanced. Prescription coverage will not be restricted to $400 a year for GEHI. Rather, the reforms propose that the ‘core’ package include prescription drug cover of $400, as opposed to the current SHB drug cover of $0 (zero). It is important to remember that the core plan has not been decided yet so the final figure may not be $400. At any rate, the GEHI cover will not be reduced.

Q18(iv) Thank you so much for taking the time to reply to my questions. I think I understand your explanation, but if you don't mind, can I just give two examples below and you can tell me if I am correct? I understand that this is just working off of the proposed figures for the BHP and they might ultimately change. Currently, GEHI users pay $55 for a GP visit. The proposed BHP includes unlimited GP visits with a $25 co-pay. Does that mean that GEHI users would benefit from that reduction in cost?

A: Yes, GEHI users and all insurance plans would benefit from regulated co-pays proposed under the Bermuda Health Plan. A final decision has not been made regarding what services would be regulated but the mock plan is a starting point for discussion purposes. Currently, co-pays vary by provider, so the $55 amount may differ depending on what an office charges. In general, most will benefit from the health reforms because it will improve waste and inefficiencies in our health system as well as introduce more preventive services to keep us healthy.

Q18(v) Currently, GEHI covers 80% of medically-necessary prescription drug cover with no maximum limit. The proposed BHP core includes $400 of prescription drug cover. Does that mean that GEHI users would continue to receive 80% coverage, after a $400 allotment is given?

A: Yes, GEHI benefits will not be reduced. The proposed $400 per annum prescription coverage is the minimum coverage that all insurance plans would be mandated to provide. The unified payment system that the government announced in August will pool all insured persons in Bermuda.

Q17) Will I get to keep my doctor?

A: The proposal aims for patients to keep their doctor. Providers are not mandated to participate in the Standard Health Benefit currently and they will not be mandated to participate in the future the Bermuda Health Plan. If they do not participate, then their services could be covered under supplemental insurance, if they do participate then it would be covered under the BHP.

Q16) Will there be longer wait times at the doctor?

A: Wait times currently vary by practice, specialty, and condition. This is a natural consequence of triage (the urgency of your needs) and workforce capacity (the number of professionals available for appropriate patient care). The goal of the proposals is for patients to get the right care, at the right time in the right setting.

Q15) What will happen to GEHI and the banks’ self-funded plans?

A: The illustrations have not been clear on this and will be amended accordingly. GEHI, BNTB and HSBC are Approved Schemes established legislatively and will continue to exist. Their mandated core, the Standard Health Benefit (SHB), will be replaced by the Bermuda Health Plan. The transition roadmap will develop how the two will interact, but the schemes will continue under those employers.

Q14(i) Where did the “estimate” of fee come from?

A: Fee estimates came from insurance reimbursement data.

Q14(ii) Has there been a current independent analysis of your “estimate”, specifically an actuary that has had access to the private insurers claim history and Specialised in health care?

A: Initial estimates are from actuarial analysis and health economic work at the Health Council.  The Health Council is the only body in Bermuda that has access to all of Bermuda’s public and private healthcare claims.  

Q14(iii) What time frame from legislation to deployment has been agreed with private insurers to prepare supplementary options for their clients?

A: The roadmap for transition to the unified system is part of the consultation process. The Ministry and Health Council are regularly in communication with insurance company representatives.

Q14(iv) What is the budgeted cost for the administration and settlement of claims?

A: This cannot be determined until a plan is finalized.  However the Health Council does maintain financial statements from all insurers regarding administrative expenses and understand the current range of costs.

Q14(v) Will this be a private entity, govt Dept., or quango?

A: As noted in public meetings, the government does not desire to administer this plan.

Q13) Will the GHP contribute to this new plan at the same rate as non Govt. employees?

A: The Standard Premium Rate is community rated, meaning all insurers have the same price for the benefits. 

Q12) Is there a cap on inflation increases or is there a real possibility we could see significant increases as a result of a bad “estimate” of the fee? Significant would be in excess of 5% per annum...

A: Actuarial estimates have always been fairly accurate.  You can read these estimates in the Actuarial Reports that are annually generated for the Standard Health Benefit (to be renamed the Bermuda Health Plan)

Q11(i) I have been avidly following discussion on Social Media about the proposed Government Health Plan and would like one point clarified please. 

A: We encourage you to use official sources of information rather than current social media, whose origins are not always well informed. See www.gov.bm/healthplan for factual information.

Q11(ii) My husband and I are both over 65 and are currently on Futurecare.  Our prescription limit is $2,000 per year with no co-pay.  Some of our medications are $100+ and last year we reached our limit just before year end and had to pay full cost for prescriptions until the start of the new fiscal year in April.  I am now seeing discussions on Social Media that the new plan will have a limit of $400 per annum for prescriptions including for those over 65.   How on earth is this going to work?   That would barely cover my husband and I for three or four months leaving us to pay full price for medication for the rest of the fiscal year!   How is this going to work for other Seniors who might be on even more medication than we are???

A: The FutureCare $2,000 prescription cover will not be reduced. The BHP $400 for prescriptions means FutureCare will either stay at $2,000 or it could be increased up to $2,400.

Q11(iii) Can you please confirm once and for all so that I can make sure I am getting the facts straight – Futurecare will not exist once, and if, the new Government Health Plan is in place and ALL patients including Seniors will have a limit of $400 per annum for prescription drugs?

A: FutureCare will continue to exist and its prescription coverage will either stay the same or increase.

Additional Information:

FutureCare, like all insurance plans, is comprised of the mandated Standard Health Benefit (SHB) + supplemental benefits. SHB covers mostly services in the hospital and lacks the prevention services to keep us healthy. The Bermuda Health Plan will expand and replace the SHB. In terms of the medications, if a person wants to keep their current level of prescription medication coverage, they can.  However in the new plan, your first $400 of coverage for prescription drugs as part of your $2000 would be paid by everyone, which would actually make the amount you have to contribute to get that $2000 worth of coverage less for you.  Remember insurance is not like a savings account where they take $2000 out of your premium and save it for you when you need to pay for meds.  It actually works that that everyone in your insurance group puts money into a pot and that money is used to cover the benefits that you signed a contract for.  If you don’t use it, someone else on the plan does.  So if we have more money put into a bigger pot, more people can have more coverage and there is more flexibility to cover the things that those people actually need to improve their health.

Q10) Please keep in mind small businesses when finalizing the insurance plan. We find it hard now with one or no insurance, how are we to afford a second insurance?

A: We acknowledge the challenges that small businesses have as it relates to offering affordable insurance to their employees. The current health reforms seek to create an expanded core plan for all insured persons in order to address the inefficient risk pooling that currently exists. To address your specific concern about affording ‘a second insurance’:

All insurance plans are mandated by law to include the Standard Health Benefit (SHB). This means that any insurance plan that you hold is comprised of the SHB premium ($355.31) + a supplemental premium (Total insurance premium – SHB premium).

The Bermuda health Plan will expand and replace the SHB. Currently the SHB covers care mostly in the hospital and lacks preventive services to keep us healthy. The reforms under consultation would shift some of the coverage from supplemental to core. We’re consulting with the public on what preventive services should be included in the core plan and at what price.

The current premium that you pay for your health insurance plan does not divide your plan into two separate insurance plans just as this is not the intent with a shift to an expanded core plan. Further consultation with all stakeholders will determine the details of how this will work in the future with a unified payment system for the core plan. See our website at www.gov.bm/roadmap-transition  and the Consultation Guide (linked) for more information about the developing of a roadmap.

Q9) I’d like clarification on an issue. I’m posing the question from the perspective of an individual, and the query relates to HIP, FutureCare and GEHI. When reviewing Figures 11 and 12 in Appendix 1 of the Health Financing Reform Consultation Guide 2019, it appears as though HIP, FutureCare, GEHI and the self-insured plans (BNTB & HSBC) will all be “absorbed” into the Unified SHB Insurer box, while Argus, BF&M and Colonial are grouped together in a separate box……however, recent conversations with co-workers plus posts from online bloggers have suggested that this may not be the case, and that HIP, FutureCare and GEHI may continue to operate alongside the new basic BHP. Can you please clarify the intent for these existing schemes once the BHP is introduced?

A: Apologies for causing confusion re the approved schemes (GEHI, BNTB and HSBC). We will correct the diagrams. In fact, the intent would be that the Government plans will be administered by the unified payor. The GEHI & FC-level benefits will be maintained (and enhanced by the BHP), but the administration would come under one body (currently GEHI is administered wholly separately from HIP & FC). Re HIP, the mock BHP is more generous than HIP so it would disappear. If the final BHP is less generous than HIP, then it would be administered by the unified payor. Re the banks schemes, they would operate like other insurers and will be added to the diagram to clarify this.

[Figure 12 in the Health Finance Reform Consultation Guide and the Unified Model graphic on the website has been corrected to illustrate how GEHI fits in the unified payment system.]

Q8) I am currently a retiree with private insurance coverage paid for in full by my former employer.  My question is, “will my former employer still be obligated to pay for the supplemental portion of my insurance plan”? 

A: Employers currently cover supplemental benefits and this will not be changed by the reforms. The details of how it will work is part of the consultation process. 

Employers are not required to provide retiree health insurance for core or supplemental benefits, but some offer it voluntarily as an employee benefit. The current reforms do not propose to mandate employer retiree health coverage of core or supplemental benefits. You raise an important point that will need to be addressed in the phased transition roadmap.

Q7) If future care covers $2k in prescriptions, why does the proposed BHP only cover $400? Where did the figure of $400 come from? What is the current average cost of prescriptions per adult and child? Currently, a private plan pays 80% brand name drugs and oral contraceptives/injections and 100% of generic drugs, will this be the case on the new plan? if a private plan covers more how do you leverage one plan over the other?

A: The proposed plan creates a legislated mandated minimum level of coverage of prescription medications for all insured residents. Regarding FutureCare, their $2000 coverage is 100% supplemental and $0 is legislated. This means that if any insurer, such as FutureCare, decided not to cover $0 worth of prescription medications now, they could do so (such as how the HIP program does).  We find this option to be counterproductive to the current profile of diseases and the burden thereof.  This plan adds $400 in legislated coverage without affecting supplemental coverage such as the $2000 for FutureCare. The $400 is for discussion, but does take into account the average cost of a prescription ($85.31) and average number of prescriptions per insured individual (6.73 prescriptions per person).  At that rate, the average spend for insured individuals in Bermuda for prescriptions is approximately $574.87.  The original proposal started at $500, but we also need to be prudent and take into account things such as premium affordability.  Please see notes (below) from discussion with Pharmaceutical sector professionals from community discussions on the Bermuda Health Council website. https://drive.google.com/file/d/1huclCrPhrb-1gGGz39SM0t7k3dLV17G_/view

Q6(i) How much less will physicians be making? Is there a concern that physicians may want to leave Bermuda? If there is a mass exodus, how do you plan on enticing doctors to work in Bermuda?

A: The BHP does not state anywhere in its proposals any request for physician revenue to be reduced. This misnomer and misinterpretation of the proposals has been stated and discussed with physicians. We do however want to ensure that everyone has access to services without financial barriers that disadvantage those that are most vulnerable.

Q6(ii) What exactly is covered with basic dental and vision? Are orthodontics covered? Are eye exams and glasses covered?

A: For both dental and vision coverage, we want to ensure that prevention is prioritized and included services are age appropriate. So for dental, this means basic services such as examinations, cleanings (prophylaxis), various x-rays, fluoride treatments (age limitations may apply), space maintainers (may and tooth sealants. Some of these will continue to be part of the integrated services available at the clinic. For vision care, we definitely believe it is important for children to have eye exams as eye issues can affect learning. And for adults, comprehensive eye exams are important not just to understand changes in vision but such exams can detect early signs of other systemic diseases, like diabetes.

Q6(iii) Please provide a list of the basic coverage for the overseas care.

A: Please see notes related to concepts of medical necessity from community discussions on the Health Council website (below). Overseas care coverage would not be basic per a set of defined procedures but rather based on physician determined access to medically necessary services that would have been under Standard Hospital Benefit if they were available on island. Such referrals for care would have to be determined, as is now, by the relevant medical professionals familiar with the case.  Right now there are financial barriers to receiving overseas care even when care is absolutely required. https://docs.google.com/spreadsheets/d/1YLiaqequ9Tca-uH_RHNkWF9NP0IHwfP4dtMZcEGoSDw/edit#gid=1709744959   

Q6(iv) If I have a preexisting condition, i.e. Diabetes/high blood pressure, will I receive the full benefits that I currently have?

A: The BHP will not have any pre-existing condition exclusions.

Q5) Would someone please explain to me why, with the new health care policy being considered, I will be required to have two policies?  My current policy, for which I pay $1.800.00 per month is more than sufficient coverage for me; why am I being required to purchase a policy which I do not need?

A: Your current policy, for which you pay $1,800 per month, is made up of a mandatory core plan (called SHB which costs $355.31) and supplemental premiums (which in this case are costing you $1,444.69). The reforms under consultation would shift some of the coverage from supplemental to core; so your split would be (in case of the mock plan example): $514 for the core plan + $1,286 for supplemental. As you know it is impossible to predict precisely what happen with private premiums year to year; so under the reforms we can’t be absolutely precise. However, in principle the shift should not inflate premiums. Rather, it should reduce premiums for many due to a larger risk pool.

Employers currently cover supplemental benefits. This ability will not be changed by the reforms. However, we note your concerns with the move to a unified payor for the Bermuda Health Plan and how this would work with a private insurer for supplemental benefits. Working out these fundamental aspects is part of the current consultation process.

Q4) As a Pediatrician I am hopeful about the possibility of bringing healthcare coverage to Bermuda's many uninsured children. In order to give effective consultation I am trying to find answers to some straightforward questions: 1. What is the budget for outpatient pediatric care (well-child and sick visits)? Through conversations with the Bermuda Health Council I know the reimbursement method (capitation vs fee for service vs other) is not yet settled but if you can give us a sense of the overall budget we can assess whether the unlimited visits +$25 copay is feasible given current utilization rates. 2. How will immunizations be funded? 3. What is included in "basic vision?" 4. Does the covered overseas care include emergency medical evacuation by air ambulance? 5. Does the coverage of hospitalization include physician fees? At the moment for infants/children with HIP and for those without any insurance we are not paid at all. It would be ideal if the sustainable platform for patient-centered care did not rely on charity.

A: The modelling assumptions have been posted online, however, detailed items like immunizations are not detailed in the dataset. Basic vision is in the spreadsheet line item #40 as an annual eye exam.  https://docs.google.com/spreadsheets/d/1OQSpfno8vu01mZw0RUYz5K4DV7FArD3pcto0QjaLMEA/edit#gid=0The mock plan budgets $43.5 million for overseas care. We intend to do more analysis in refining what should and can be included for this budget. We am concerned about HIP not paying physician fees and we are investigating. We concur that the plan must not rely on charity – whether it’s pro-bone work or go-fund-me pages or bake sales. True financial risk protection is the hallmark of proper universal coverage.

[The data requested was provided directly to the enquirer with further dialogue continuing.]

Q3) I am very Interested in reducing Health care costs in Bermuda and have worked and lived in various jurisdictions that have a single payer system. I think a consultation period needs to be a LOT longer than 4 months (probably more like 18 months?) as this will impact bermuda for a very long time and there are so many things to consider! Other countries who have the funding of taxation have taken 2-3 years to develop changes. Being a small country we want the best care for all and this requires defining which areas to change first to benefit the population with a 5-10 year outlook I think most people are confused by the current and proposed plans and would like to see a series of public forums (maybe per parish and also per patient group??) that more simply explain it.

A: We fully agree that consultation will take more than 4 months and implementation will necessary be phased over multiple years. The 4 months are only the public-facing roadshow of town halls, etc. But the collaboration and engagement will continue throughout.

Q2) I agree that this seems very rushed for something that could be literally life and death for someone. There is so much to consider and the information currently available is a long way from comprehensive. I would very much like to attend a public discussion panel where patient advocate groups, medical professionals and representatives from the insurance industry were able to ask those involved in planning these changes questions and get actual answers (not the standard “I don’t have that information to hand, we’ll get back to you on that” then never do). I am not an insurance expert or a medical professional or a financial expert so I don’t even know where to begin to ask questions beyond how much is this going to cost me? What effect will it have on my GEHI plan, and will I still be covered for everything I am currently covered for? Does this change how I make a claim? Will I have to pay out of pocket then claim the money back like I have to do with certain things now? The information provided so far is pretty sparse on facts and seems to me to be trying to present those very few facts in multiple ways so they look like a lot of information when it isn’t.

A: We are looking at doing a panel discussion including a broad range of stakeholders and, of course, the patient’s voice. Please keep an eye on our notices. If you want to be added to our mailing lists just email moh@gov.bm to request it.

We apologize for causing confusion re GEHI. We will correct the diagrams. In fact, the intent would be that the Government plans will be administered by the unified payor. The GEHI-level benefits will be maintained (and enhanced by the BHP), but the administration would come under one body (currently GEHI is administered wholly separately from HIP & FC).

The premium impact to a plan like GEHI should be favourable due to the larger risk pooling and GEHI’s current (high) risk profile. But we can’t tell the final figure until the final core plan is decided.

There’ll be no changes in how you make a claim, but we should see improvements in the speed of reimbursement.You shouldn’t need to pay out of pocket for many things now, as upfront charges are illegal (with some exceptions). If you are having a lot of out of pocket payments please let healthcouncil@gov.bm to report it.Thanks for the feedback on the information. We take it onboard and are working on clearer graphics now that we’ve had more feedback like yours.

[Figure 12 in the Health Finance Reform Consultation Guide and the Unified Model graphic on the website has been corrected to illustrate how GEHI fits in the unified payment system.]

Q1) Where are the actuarial studies to support the financing that has been proposed with the benefits that are currently being proposed? Will Bermuda go bankrupt like Turks and Caicos has over their plan. Will we go down the same rabbit hole that they did (promise the world, figure out they couldn't afford it and then claw back the benefits that people thought they would be covered for..) Will items such as surgeon fees, immunizations, durable medical equipment, air ambulances, commercial flights for referred care... etc be included. The proposed pdf released by acting Minister Tyrrell on August 23 that shows that you could get up to $50K a year for overseas care just doesn't cut it in serious cases (i.e., trauma, neuro surgery, premature births) (but could be as low $2500/year if they go with a lower plan - that barely even covers 1 trip to a specialist off island with the testing that would be ordered) and even on island $400 doesn't even come close to covering medication - with the average diabetic spending $5K a year in meds as per the figures from one diabetic education program, then $400 is just a drop in the bucket. Will employers drop the supplemental coverage from their current carrier? Will employees be able to afford supplemental coverage as the BHP isn't proposing to cover enough to cover for catastrophic care Who is this really trying to assist? What are the goals and what are the figures relating to this. Most people don't have a problem with assisting people when needed, but this is a major change to the healthcare system to a socialist system. How are you going to force the doctors to come on board to the capitation and to this program as they are private businesses.

A: The modelling assumptions are online here: https://docs.google.com/spreadsheets/d/1OQSpfno8vu01mZw0RUYz5K4DV7FArD3pcto0QjaLMEA/edit#gid=0    

Bermuda’s core insurance plan has been fiscally managed for years. The actuarial reports are published here: http://www.bhec.bm/actuarial-reports/    

For evidence of Bermuda’s track record in managing health costs see this article: https://www.gov.bm/sites/default/files/Healthcare%20Cost%20Curve%20Issue%20Brief%20-%2027%20February%202019.pdf   

The mock plan contemplates $43.5 million for overseas care. The purpose of the consultation is to hear feedback on what the final plan should look like. Many have stated that $400 for pharmacy is not enough and we have taken note.

Employers currently cover supplemental benefits. This ability will not be changed by the reforms.

The purpose of the reforms is to assist Bermuda as a whole by creating more efficient risk pooling and a core plan that helps people stay healthy. The Consultation Guide has more information: https://www.gov.bm/sites/default/files/Health%20Financing%20Reform%20Consultation%20Guide%20v1.3%20190930.pdf    

The matter of capitation is an open discussion a long way from a conclusion. Currently vocal doctors are opposing it and behind closed doors some doctors see the merit. Having discussed it we are working on further modelling on the pricing. But it is not yet decided.

 

COMMENTS AND RESPONSES

On Friday 6th December the healthplan inbox began receiving “cut and paste” objection emails provided to the public by the Patients 1st campaign. Highly similar comments have been consolidated to avoid repetition.

C68) I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea.

60 comments containing this statement were received and acknowledged.

C67) [See Q57 for answered questions] I am opposed to the proposed health plan. Several reasons are :The standard of available care inevitably would decline materially due to inflexibility and mediocre management. Nothing run by any government can be as efficient, innovative or cost effective as private sector services, The relatively small number of presently uninsured persons can be provided for by government separately without placing a crippling over burden on the provision of health care to the remaining 95% of the population, Access to health care will inevitably decline to the level of the unsatisfactory standards presently experienced in the UK and the health of the entire population will be worse off than at present. Somewhere within government there is a concealed agenda on this subject and until it emerges the proposal should be put away on that shelf where all bad proposals end up.

A: As an interested citizen you may wish to consider further reading on health systems. The following are useful references:

“The Healing of America”: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779642/

Health in Review: An international comparative analysis of Bermuda health system indicators

https://www.gov.bm/sites/default/files/Health%20in%20Review%202017%20%2C%20%202nd%20Edition_0.pdf

C66) [See Q56 for answered question] I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda Furthermore this suggest a communist approach to healthcare when Bermuda does not operate on this social system. Had I known that my hard-earned money, the future of my soon-to-be-born daughter and overall health would be compromised, I wouldn’t have voted at all.

C65) [See Q53 for answered questions] I am only a holder of a Residency Certificate who has been living here for the past 11 years. Bermuda is my home. I have contemplated long if it is right for me as a white female foreigner in this country to write this email. I feel it is right, I am paying a substantial amount in Land Tax, I employ one Bermudian and two guest workers, I try to buy as much as I can locally. My employees are HIP insured, I am privately insured by [redacted private insurer]. Coming from [country redacted] I am used to expensive health care insurance. However, the system is transparent, modern and gives monetary option to which extend the individual wants to be insured. Individual responsibility for health and dental well being is very important and the health insurers honor it with lower premiums for those with lesser doctor’s visits. I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. Please do more research, broaden your horizon to other countries health care insurance systems, not just USA, Canada and UK. I am also missing the information regarding supplemental benefits to be bought from private insurers. How easily could they renounce/cancel my private insurance? Why not team up with an international insurance company like BUPA for the whole of Bermuda and spread the risk wider? Please re evaluate and give consideration to the voices raised by concerned patients and doctors.

C64) [See Q52 for answered questions] I would like to express my concern about the new health care plan.  It is obvious from everyone I speak to that this plan is not supported by Bermuda.  There has to be a better way and there is no reason to rush something through that has so much disagreement from the public and is raising this much concern.  Our health insurance is very important and as a parent with a Type 1 diabetic child recently diagnosed that has to go off the island twice a year how will this work on a government plan that doesn’t cover what we currently have and how much will a supplement plan cost that the insurance companies of this island are not on board with. This is not a democracy at this point but government not listening to there people and doing what they want to do.  Please consider the consequences of what you are doing. 

A: This work started in 2012 with a bipartisan task force. It was further consulted on in 2018 and implementation is estimated at 3 – 5 years. Reforms won’t be rushed and will be done in consultation with the people affected. We attach and FAQ and an explanatory video for your information: https://www.youtube.com/watch?v=eb_GzBh0dUU&feature=youtu.be

C63) [See Q50 for answered questions] I have worked for the government and I have very little faith that your system will serve the people.   GEHI is already ineffective and isn't run well, how can you assure us that your new system will run better?  I would rather have private health insurance from my employer that have this shoved on the me. What will happen to the people who can ill afford health care even if their income is too high to receive benefits from the government?  Why not have a system like the NHS to serve people who can't afford health care and charge us a tax? 

C62) [See Q49 for answered questions] I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda. Please focus your energy on addressing the root causes of the out of control health costs. Please answer this: If your plan does get enacted, how many more civil servants will be added to an already bloated CS?

C61) [See Q48 for answered questions] My ideal health plan coverage is major medical, with major dental and eye care, and if that cost can be lowered without causing interruptions in my expectations, than I will be good for it, but if this proposal is going to cause interruptions and higher costs because I will need supplemental insurance at a higher cost I am paying now, then  I will not agree with this at all.

A: Your feedback will be considered as part of the consultation process.

C60) [See Q43 for answered questions] A place so small as Bermuda should pool everyone together to better manage risk, and also eliminate the costs of administrating multiple healthcare plans.  I hope that in due course further cost savings benefits can be had by ensuring conflicts that currently exist in the system are addressed.  I believe everyone can agree that a doctor needs to decide whether they want to be a doctor or a businessman operating a testing facility.  While I understand there might be some advantages of having some testing done in the private sector to alleviate wait times, I hope that in due course the govt understands that it is very counter-productive to allow practicing doctors to also be the ones owning or controlling those labs…meaning there should be rules governing who is allowed to be a shareholder of such businesses. Again, thank you for your time…and I wish you the best in trying to bring about a better healthcare system for all.

C59) [See Q42 for answered questions] Who will be administering the new plan? What company will you liaise with to cover overseas treatments? Will it be managed overseas? What tier of hospital overseas will be able to use?  If it is not a gold standard with the best care then it will not be acceptable.  How do we know that a few months into this forced health care reform an accountant in the health department, overwhelmed with overseas applications for treatment, decides to down grade our care to a cheaper hospital alternative where we will then not get the superior or appropriate care we should be receiving? How many Bermudians working at Argus, BF&M, Colonial, Moongate etc. will lose their jobs as a result? I am not employed by any of these companies.  I am concerned that this reform will have a fall out of job cuts and company closures. How many Bermudian shareholders of Argus, BF&M, Moongate, etc. will end up losing a significant portion of their investments as a result of this?  I have no investment in any of these companies.  I am concerned that those who do have investments in these companies will lose their investment or have a significantly reduced dividend which will result in less funds for monthly/yearly income streams which directly affects their purchase power in Bermuda. How many Bermudian doctors and dentists will end up having either to close their business or leave their own country as a result of this new plan? I am not a healthcare professional.  I ask this question because I want the choice of care available that I currently enjoy, the overseas top notch care that is available currently to me and my family if needed either voluntarily or urgently. How many new expat doctors and dentists will be brought in to replace them? Will we be getting high quality replacements?  How will you vet this process?  So far this plan sounds like a way of displacing Bermudians and gaining control of the health care money and nothing to do with offering better healthcare. The Government needs to provide the answers. We cannot compare our small island with the UK or Canadian unified schemes as firstly, they have much larger populations that are growing and they have all of the technology and resources available to them through research and university hospitals and drug companies etc, we do not.  We import everything! How many people in Bermuda are NOT covered by private health care?  There does not seem to be a definitive number and this is crucial.  Penalising the many to cover the few is not right in anyway, ask any school aged child when their teacher says everyone stays behind after class because one child was naughty, it is not fair or right.  No one likes to be penalised for something they didn’t do or do not agree with. Taking away choice and forcing something upon the people never ends well.  Keeping my choice of health care and looking to the Government to spend their funds more wisely with more accountability.

C58(i) I am absolutely in favour of universal health care HOWEVER I am not in favour unified financing. This is an enormous proposal and one which must NOT be rushed. I think there are many improvements to the dual system, which could be implemented.

A: We can assure you that the reforms are not rushed. Development began in 2012, continued in 2018 and a 3 – 5 year implementation is expected starting in a year’s time.

C58(ii) Listen to the doctors, who spent years training to enable them to deliver the very best care. I believe we have some excellent doctors in Bermuda. I fear many may leave if this NHS style health system is implemented in haste. Doctors and other health professions left UK in droves when the health system started to fail.

A: Changes will be made in consultation with the people affected. A unified health financing system is not the same as the NHS. The Bermuda Health Plan proposal is to continue to combine private and public sectors, just as we do now. The intent of the reforms to add more benefits to the core plan will take into consideration the views of physicians as well as nurses, allied health professionals, insurers and other healthcare providers.

C58(iii) My suggestion is that rather that change the entire system it would be preferable and much simpler to simply provide adequate health care for the 5000 people who are uninsured. The Patient Centered home at KEMH (the former Indigent clinic) is excellent however patients cannot self refer but first have see a GP for a referral...many cannot afford this.

A: Bermuda’s challenge is not only with the uninsured, but with the under-insured – i.e. people with chronic conditions for which their insurance does not cover them. A larger risk pool with chronic disease case management and prescription drugs covered would enable everyone access to the care they need to address chronic conditions.

C58(iv) I fear that the percentage of uninsured or under insured with rise enormously if the Government try to run the health care system. Presently getting insurance reimbursement from GEHI takes months compared to other insurance companies. Many parish Government clinics have closed or are open only once a week making access to health care difficult for those unable to see a private doctor. If this is an example of how the new Government run health care system will work it is indeed very worrying. 

A: The government will not be providing additional services under the reforms. On the contrary, the intent is to make use of private healthcare providers to offer covered services. Other government plans have processing and payment times that are comparable to private insurers.

C58(v) Increasing access to prevent and manage non-communicable diseases and expanding community based health care would be ideal.

This is exactly the intent of the Bermuda Health Plan.

C58(vi) Open Airways, Bermuda registered charity is an great example of an Island- wide education program, working together with existing health care agencies, [they] have reduced hospital admissions for asthma by a staggering 83% in the past 22 years. Improved quality of care through prevention is the only way forward but we must all work together to make this happen. Please listen to those who have spent their lives devoted to improving health care. I do not believe politicians can do this.

A: We agree wholeheartedly with you. Attached are some FAQs and you may also see this summary video which we hope will assist: https://www.youtube.com/watch?v=eb_GzBh0dUU&feature=youtu.be

C57) I attended the Age Concern forum this week and it was wonderful to see the engagement. I was actually excited to see the turnout and desire for change.  It also caused me doubt.  I want to state that in my role as a nutritionist and as a consultant in healthcare both in Bermuda and internationally-  I see everyday the need for more preventative care. One of the  panelists highlighted the need for this very strongly. Sometimes we have health care backwards.  We need a proper plan that includes changing behaviors BEFORE we are sick. It requires long term thinking. I had written months ago suggesting our sugar tax be partly used to fund all public schools to have a small plot of government unused arable land to farm on- simple, inexpensive, easy to implement. I received zero response. I have thought long and hard during the public consultation period about where I stand. I questioned friends in both political parties, physicians, nurses, elderly and my younger employees to remain unbiased. I have always believed strongly in universal health care with a preventative care approach, but I cannot- in good conscience- support a unified single payer system. The risk outweighs the benefits. I have financially reviewed the google documents, I have shared them with Canadian, Bahamas, Jamaica and European consultants and officials in government and in healthcare and I have been unable to have any of them agree that we would be better off with a unified single payer system. All referenced two concerns: need for taxation in place 1-2 years ahead of unified or proper funding in place through premiums and the need for independent review. I am 100% in favor of ensuring those without insurance and the under insured are our first priority. Regretfully, as an initial supporter of the proposed changes as well as the original initiatives of the PLP health platform intent, I cannot agree with the unified system as the foundation these changes are based on.

A: Bermuda already has significant taxation contributing to overall health financing. Currently, $192 million, or 26% of total health financing, comes from the public purse. A further $140 million comes from legally-mandated premiums in place since 1970. It’s important to consider the current financing mechanisms and the existing role of the government and legislation. The SHB as a core plan is already in a virtual single risk pool that is community rated. The step from the current system to unified is not as large as it may appear.

C56(i) This email is to record that I am not in support of the proposed health care reform as presented; I would like to see more details before this moves forward.

A: Some FAQs are attached. The modelling assumptions can be found here: https://docs.google.com/spreadsheets/d/1OQSpfno8vu01mZw0RUYz5K4DV7FArD3pcto0QjaLMEA/edit#gid=0

C56(ii) I agree that health care in Bermuda needs to be reviewed to better accommodate all residents. My concern with existing proposal is: - changes will need the full support of the medical profession in Bermuda to be effective - the profession has been vocal in highlighting problems

A: A group of health professionals has organized to oppose the reforms, but all health professionals are not united in their opposition. For example, there are over 2,400 health professionals in Bermuda but only 75 are members of the association opposing the reforms.

C56(iii) - it monopolizes the provision of basic health care services, thereby reducing competition - what checks and balances will be in place, and how will they be implemented

A: Bermuda's population is small from an insurance pool perspective. With insurance it's the law of big numbers that makes a difference in managing risk. The standard health benefit is already in a virtual single pool and the premium has been community rated since 1970. Grouping the core plan into a single risk pool will be more efficient. Like many public goods, this is not about a monopoly or a market but about how effectively it is regulated and how well it serves the population. The Government is seeking to establish a larger, more efficient risk pool that will create a sustainable platform to improve access and sustainability in our health system.

C56(iv) - will top-up health insurance cover be available and if so at what cost - my current level of benefit is important to me

A: Supplemental insurance will be available. The cost, just like now, will vary depending on a group or individual’s risk rating. This is exactly what happens currently.

C56(v) Additionally, I believe reform should be in stages, with initial focus on providing basic care to the un-insured / under - insured, rather than throwing out a system that works for many people.

A: The intent of the reforms is to roll them out gradually over 3 – 5 years.

C55) I am deeply concerned about the above. Having battled cancer twice in the last ten years and with only one insurance company that will give me health coverage I am loath to having anyone interfere with that coverage. I am opposed to a unified health scheme because I don’t think a government sanctioned Insurance monopoly is a good idea. There are other ways to effect responsible health reforms that carry less risk for my family and for Bermuda.

A: To respond to your concerns, currently $355.31 of your current insurance policy is the mandated core package (the standard health benefit which covers largely local hospitalization). The reforms would mean more of the core plan would be in the mandated core package. It would not take away anything from your existing supplemental cover. The creation of a unified payor for the core plan means persons with a pre-existing conditions like yourself will have more protection from premium fluctuations and reduced risk of being denied coverage for a pre-existing condition.

C54) Hey, lets slow down and let all stakeholders and experts discuss this rationally. Forcing people to do something will backfire on you. The sugar tax was not right. You only increased the cost of living all around and have made it tougher on poor people. First you should have targeted obese people who should be paying higher premiums, You can also cut the fat out of the current system with Hospital officials getting over-inflated salaries which may have been acceptable 20 years ago. This is a new economy in Bermuda and too many people are living beyond their means or at the expense of others. The civil service needs to be cut back or their salaries need to be cut back, so those in the civil service can keep their jobs.  IF THE GOVERNMENT CAN’T CONTROL SPENDING AND GET THE DEBT UNDER CONTROL, WHY WOULD A GOVERNMENT SANCTIONED HEALTH PLAN WITH THE SAME GOAL WORK? SOCIALISM ONLY WORKS UNTIL YOU START RUNNING OUT OF OTHER PEOPLE’S MONEY (Margaret Thatcher).

C53) I am writing in concern to the proposed universal health plan. I am a born Bermudian and have been in good health most of my life until 2017 when my entire way of life was turned upside by a chronic pain illness. I was a very active person and health conscious so when I was faced with this illness it really compromised my quality of life. I almost lost my job and lost my desire to live in constant pain. I couldn’t give up so I kept pushing on till I found a group of medical professionals that helped me regain my quality of life. I now have to be on constant “maintenance” so that I do not live in constant pain. I give you this background because without my health insurance I will not be able to afford the medical interventions that keeps me going (physiotherapy, chiropractic care, osteopathic medicine, and GP visits/medication).My fear regarding the plan is that it will not give me sufficient coverage to keep living. I cannot afford supplemental insurance and my family and I would have to sincerely consider moving off island so I could receive the care I need. I have a one year old daughter and a husband that depend on me and I worry how this would effect us all. I have many friends in the UK and Canada who continually lament over government provided health care and having lived in the UK myself have experienced the lack of care from the NHS. I agree that our healthcare system is flawed but I beg the government to think of everyone this will effect. Because I do not fully understand what the universal plan will cover and am afraid for my own quality of life (plus others in the same predicament) I am not in favor of the proposed plan on the table. Please advise if you have considered these medical interventions in your universal plan.

A: Thank you for taking the time to express your concerns. To respond to the points you raised, most of the insurance you have currently IS supplemental insurance. Only $355.31 of your current insurance policy is the mandated core package (the standard health benefit which covers largely local hospitalization).

The reforms would mean more of the core plan would be in the mandated core package. That is all. It would not take away anything from your existing supplemental cover.

The intent of the plan is to roll in more benefits gradually over time. The creation of a unified payor for the core plan means persons with chronic conditions like yourself will have more protection from premium fluctuations and reduced risk of being denied coverage for a pre-existing condition.

C52) I am writing to you both as a concerned Bermudian. I respectfully ask that more consultation is needed and personally I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda. As my MP and our Minister of Health, I ask you to do the right thing and re-evaluate this proposal, and allow more time for discussion and consultation from stakeholders- mainly us as the public who will be most affected.

C51) Please accept the as my complete opposition the unified health scheme proposal as put forward by the current PLP Government.  I don't believe  a government sanctioned insurance monopoly is in the best interest of the community. I believe that there are other options and ways to effect responsible health reform that carries less risk for my family and for Bermuda. I would respectfully ask that the PLP put the brakes on this proposal, listen the the seven thousand plus Bermudians who vehemently oppose this proposal and head back to the drawing board.  The proposed Bermuda National Scheme is a disaster waiting to happen in my opinion.  Nearly twelve percent of Our People , from all walks of life cannot be all wrong.

C50) I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda. I am paying enough for my health insurance now and to hear that my employer will not have to pay 50% of any supplemental insurance will mean that I will end up paying more for my insurance and I do not agree with that.

A: Your employer currently does not have to pay any of your supplemental insurance. Employers do so voluntarily by convention. The reforms don't propose change this. They would simply mandate coverage they are already paying for.

C49) Definitely NO to the proposed unified financial scheme. That gives money to Government.  _PLP got us into this financial mess - let them  find another way to get Bermuda out of debt.  PLP keeps spending money as if there was no tomorrow.  Cut back on the civil service for a start and paying government members. 

C48) I am opposed to a unified health scheme because I don’t think a government sanctioned insurance monopoly is a good idea. I will not pay for this. Government should not force decisions on people. Do the referendum. Provide more details. If this is better than what we have now – prove it! Show numbers. Show in detail how it is going to work, how it is going to be better.

C47) I am for Universal Health Care, but totally opposed to the Unified plan being proposed by the government. How does the government know what’s best for me? Let the professional health care providers, i.e. the doctors and nurses, decide. And let me decide what I want!

C46) It is said that for every person who expresses an opinion publicly there are at least 10 more who never get round to it.  Over 7,000 people have signed the petition to re think the government plan on health reform. Multiplied by 10 that is more than the entire population of Bermuda. I hear that our Government has ignored this petition. Is this democracy?

C45) I am opposed to a unified health scheme because I don't think a government sanctioned health monopoly is a good idea. Having family members with serious health issues living in the UK, I know they problems they have experienced with the same type of plan. Bermudians are in for a rude awakening if this government takes this step.  There will be no going back.

C44) I truly hope that public opinion will not be ignored, democracy is being threatened globally and it is the duty of the government to listen to the people. I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda. Although I do think changes need to be made to Bermuda’s health care system, I believe that pushing this scheme through is reckless and irresponsible.

C43) Please note that I am very concerned about the proposed Govt. HealthPlan for 2020 and beyond.  I cannot support it as it currently 'drafted' because there has been little or no detailed information on how it will actually operate provided during the Public Discussion period. Please register my opposition to the Plan, until you are able to give us proper detailed information on which we can make an informed decision. I know this e-mail is probably a waste of time.   25-11   Whoo hoo.

A: You will find considerable information on www.gov.bm/healthplan

C42) I don’t believe that the words democracy, and government sanctioned monopoly health insurance scheme, can sit comfortably together.  It seems a risky business for this government to ignore ‘the people’ they have been democratically elected to represent. The majority of health professionals who work on the front lines every day, think this is a poorly thought out scheme.  It seems they are about to be proven right.

C41) Based on the limited information that is currently available from Govt. ministers, I cannot support the Unified Health Insurance Scheme as proposed. There has been so little detailed information that has been provided in the 'public consultation' process, it is impossible to support it.

A: You will find considerable information on the website: https://www.gov.bm/healthplan

C40) As an employer of over 100 comprehensively insured employees, I have grave concerns over transitioning to a unified health scheme.  It will have unintended consequences that will make my employees healthcare choices and costs WORSE than they have now. This is unacceptable to my employees. I therefore exhort you to broadly consult with all stakeholders (patients, employers, health care professionals and government) to come up with better ways to increase efficiency and lower costs in healthcare delivery for all Bermudians, rather than this current path. Please stop executing the current plan.

C39) I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda. I believe we are putting the cart before the horse. In my opinion immigration reform should be the priority, which would have a more positive effect on our community as well as the state of our health care.

C38) I am definitely opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda.  All government needs to do is make it a law that all doctors have to post their co-pay charges in their office and on a website.  This will create competition and make it feasible for those who are counting their pennies to choose doctors who are not charging the earth. There is no way that our government can run a healthcare plan on top of what they should doing now.  Stop the nonsense.

C37) I  signed the petition relative to the planned change in health care and ask  that Unified health financing be withdrawn and alternative reforms be  considered. Please  slow down and reconsider what is best for all Bermudians.

C36) I beg you, please stop this plan right now.  It is a very bad idea.  It will end up with my having to pay more for the coverage I have now as it will mean an additional policy to cover what this plan will not. We all agree that the present system needs improvement but this is NOT he way to do it.

C35) I think it would be prudent if the consultation period be extended, as the issues and proposals are only now being understood by the population. At a recent "Age Concern" meeting the panel were entirely biased and there was no representation from any affected party such as Insurer's. In my opinion it is very unwise for a single entity to run any scheme, business or service as it degrades consumer choice.

C34) The unified health scheme is an expensive and wasteful exercise in increasing government spending.  It will be inefficient and will not address the needs of Bermuda’s population – especially the aging population effectively. Private enterprise will always be more efficient than yet another government department.

C33) Good day. I am writing to lodge my strong objection to the Bermuda government's attempt to paralyze Bermudians' healthcare. The government's plan does not have the support of the people of Bermuda, as is evidenced by the 7000 plus Bermudians who petitioned against it. The plan is therefore UNDEMOCRATIC: a shameful attempt at authoritarianism by means of a war against Bermudians' health -- against the very bodies of the citizens which the government has a duty to protect.

The drastic reduction in the amount and quality of the healthcare available to Bermudians which is the aim of this plan will result in terrible physical suffering for even this government's supporters. Not to mention the many, many healthcare workers and insurance company employees who will lose their jobs, the island-wide consequences of which seem to be of no concern to the present government.

There is no doubt that the highest government echelons, which again and again demonstrate contempt for Bermudians, and who stand to benefit personally from the healthcare plan, will seek their own healthcare overseas, abandoning their people to slow and painful deaths from medical conditions which should be preventable and treatable.

C32) I am opposed to a unified health scheme because I don't think a single, government sanctioned insurance monopoly is a good idea. It certainly isn't addressing the high costs of health care. More research and time needs to go into finding a real solution with our existing insurance companies and health care system. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda. I agree that there are many who are uninsured, or under insured and that change is needed. But you haven't convinced me that a complete change in the system will be a viable solution. I am asking for more time to collaborate a solution. Thank you for your efforts, on behalf of my concerned bermudian family

C31) Please do not implement this new health plan. Instead just impose a schedule of fees that doctors have to follow. That would sto pl the goiging that some do.

C30) Please be advised that I wish to object to the unified health scheme as I believe that, although we are in need of reform, there are better ways to do it without establishing a government controlled monopoly. Such have been proven historically to fail and we cannot afford to do that with our people and their health matters. Thank you for registering my objection

C29) Understanding the need to re-evaluate health care in Bermuda I believe there are numerous ways to improve opposed to the proposed plan, which for me, lacks critical information. it is unfortunate but true that once you take the money out of medicine, when you are no longer a paying customer with alternative options, you lose your leverage. You are at the mercy of the system. Complaints will go on deaf ears. I believe more focus/money should be spent on care with a five year plan to re-evaluate.

C28) I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. I have spoken to my doctor who has worked in systems similar to that being proposed for Bermuda. In his opinion it will only reduce the quality of Healthcare whilst at the same time increasing the cost. A government is not a Health provider and has no experience of administering such a scheme. Governments in Bermuda, ALL governments not just the current government, have a poor track record of delivering services to the people of Bermuda, I do not see how this government, or any other, would be able to successfully deliver the Health System suggested in these proposals. I my view these proposals are poor and not good enough for Bermudians. In addition they are being rushed through with NO understanding of how to administer such a system and finally without having any REALISTIC idea of the cost of such a system. Thus, I for one, am totally opposed to the CURRENT proposals for a unified Health System.

C27) I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda. This plan is rushed and as presented in the meetings, not well thought out.  The doctors and other health care professionals of Bermuda do not buy in.  I do not buy in.  My family does not buy in. We all agree that Bermuda's health care system must be improved and we can achieve UNIVERSAL coverage - that's very different to the UNIFIED financial scheme that the government is proposing.

C26) [Link to www.change.org/p/government-of-bermuda-the-people...]

C25) I am writing today to inform you that I am opposed to a government unified health insurance plan because I do not agree with having a government sanctioned insurance monopoly.  We all agree that Bermuda's health care system must be improved but there are other more efficient ways to effect responsible health care reform.  We can achieve a Universal coverage scheme rather than a Unified plan, which Government is proposing.  A petition against this present plan has been circulated and it is now 7000+ signatures strong.  There is obviously clearly a strong desire by the Bermuda public for the Government to put their plan on 'pause' and consult further with all affected stakeholders and come up with a better alternative.  Please accept this email as my formal objection to the Government's proposed mandatory unified health insurance scheme.

C24) Good day - please be advised that I am opposed to a unified health scheme being rushed into effect as this critical issue requires ample thought and additional consideration of other ways to effect responsible health reform including a scale of coverage for elderly vs younger patients, prevention over medication, etc. and I am duly concerned about my Parents who struggle today to keep their health and health Insurance Plan within acceptable cost and benefit parameters!

C23(i) I am strongly opposed to this being rushed through. 

A: This process started in 2011. A 3 - 5 year implementation period is expected. The reform is not rushed.

C23(ii) The cost of health  control  care needs to be addressed but rushing this through and not considering alternatives is not the answer.  At the very least, the consultation period ends to be extended.

A: A four month public consultation period has provided fulsome dialogue for all stakeholders.

C22) [2] I vote NO to unified financial scheme that gives money to the government at the expense of our health care.

A: Thank you for your submission. Your feedback will be considered as part of the consultation process. If you can provide data or evidence to support your concern, we’ll be happy to assist with a more fulsome response.

C21) I am opposed to a unified health scheme because I don't think a government sanctioned insurance monopoly is a good idea. There are other ways to effect responsible health reform that carries less risk for my family and for Bermuda.

C20) As a stakeholder and Bermuda resident I don’t support unified health financing. I support health care reform that is well considered and has a majority support by stakeholders. I believe that the working poor will not be able to afford health care, but persons like me will be able to afford supplemental care. These changes will replace a two tier system with another two tier system that will accentuate the have nots verses the privileged haves and which will deepen the social divide between classes and result in a private health versus public health care system.

C19) The CANADIAN HEALTH CARE SYSTEM WORKS BY COLLECTING /GENERATING TAXES  WORKING PEOPLE PAY INTO BY PROVINCE TO OPERATE. The citizens of Canada that don't work have free access to get treated in hospital. Its not free but the people who work get free health care, there taxes are deducted, e.g. INCOMETAX. They don't pay, e.g. $500.00/MOUTH, the money is generated by taxes not mouthy premiums. Could this work here,, thanks.  Health care for every legal Canadian citizen working or not, just as long as you get the medical card issued by the Canadian government.

C18(i) While I agree that there is a need for reform in the health insurance field, I do not have confidence in what the government is proposing. I think there are other options that should be explored through the private insurance companies. (They should pool all policy holders into one "group" or plan, which would result in fairer premiums). 

A: This is exactly what the Bermuda Health Plan proposes: to “pool all policy holders into one ‘group’/plan” administered by a private insurer.

C18(ii) But, obviously the government is only appealing to their base voters and not the broad population. It appears that we are all going to subsidize the government's GEHI plans as well as HIP and FutureCare. As recently demonstrated in the news, there are government employee groups who do not pay any premiums for health insurance. (Prison Guards). (Gov't retirees?) 

A: This is not correct. Some uniformed service have their full insurance paid by the employer. But the vast majority of GEHI policy holders pay half the premium, just like private sector employees. HIP and FutureCare are already subsidized by all public and private premiums at $35 a month. This transfer has been in place for over a decade.

C18(iii) So now you want the majority of the public to subside the government's bad contract deals that have been made with the various arms of public employee groups. The government owes the public some transparency on these costs and subsidies.

A: You can find the actuarial reports and national health accounts at www.bhec.bm

C17) My feedback is simple, please do not proceed with anything like the current plan. Our government has too many things to focus on to take on the monumental task of MANAGING the island's health insurance. Does our current health program need help, of course! Should government be involved, of course! However, a required and very hard to reverse change to a mandatory program that has not been fully developed is not the answer.   Negative possible consequences of this program are endless but here a re few:

-loss of coverage

-increased costs

-insurance losses to government, increasing national debt. One of the main reasons being offered as justification for this program is the poor general health of our population. That inherantly means that the program will face far higher costs than other countries.

-loss of jobs (where to all the local health insurer staff go?)

-a further growth in the relative size as the bermuda government as the largest employer on the island (see above)

-loss of international business. Discomfort with our political climate among international business is high, giving the decision makers reason to question whether their families healthcare will be adequate will only add to that.

The bottom line is that the Bermuda government does not have a good track record of financial management. This is not a party based view, I can say with full honesty that I would be NO more comfortable having the opposition manage my healthcare than the current one.

Please, take time to figure out how a base level of care can be offered for all bermudians WITHOUT creating a mandatory program that will remove choice for those already with good care.

C16) On Behalf of "Patients 1st", a large group of concerned Bermuda residents have signed this petition to express their lack of support for Bermuda moving to a unified health system. Please accept this petition with its thousands of signatures as a statement by the Bermuda public asking:

1) to extend the public consultation for health care reform and

2) that a statistically significant number of Bermuda’s population is not in support of government’s decision to force a unified health plan.

We ask that the government withdraw its proposal of a unified health care system and consider other reforms.

A: Dear Patients First, I write to acknowledge receipt of your email of 4 December, 2019. Please note that there was no attached Petition provided.

In any event, as a Government, in 2017, we were elected under a platform commitment that we would take steps to address the unsustainable cost of health care, whilst ensuring that everyone has affordable access to healthcare. 58.9% of the electorate supported the above position and we have been clear since then of our intentions.

In order to obtain this goal, following a year-long consultation in 2012 and again in 2018, we determined that a unified health financing model will best meet our objectives of improving efficiency, sustainability and providing healthcare assess for all.

As I have stated previously, the four month public consultation, due to be concluded on 8 December,

2019, was to seek input on both the benefits package and the transition Roadmap.

Stakeholder discussions will continue as we seek to establish working groups to consider the public feedback and drive the next phases on the reform to meet the Government’s policy objectives.

Thank you once again for your continued participation in the democratic process by facilitating the production of the Petition.

C15) The monies put in to the insurance plan a large amount seems to go to the hospital. For this reason the hospital and their services need a serious looking into.and the services that they provide you can stay at home and do . So many complaints and nothing but patients deaths continue.

A: You are correct that the majority of the current basic plan goes to cover hospital services. The aim of the reforms is to direct funds and coverage for other essential community-based healthcare. 

The Ministry of Health is working closely with the hospital on its funding and services. In addition, the hospital has a proactive service improvement plan and is internationally accredited to assure good quality to our residents. However, if you have a concern about a specific patient's care, we can connect you to the right person at the hospital for a response.

C14) I am Bermudian and lived in London for 15 years before coming back so I have some experience of the NHS and have suggestions about how we can cut costs here:

1) change the law to allow trained nurses to be able to do more medical procedures. In the UK, nurses have far more responsibility than they do here for procedures. Meanwhile, we accept consultants doing some of them! 2 examples:

A) nurses do Pap smears in the UK while here women are able to go to their consultant gynae for them. Going to a consultant for that is a ridiculous waste of money. GPs can handle normal physicals, no need for an annual gynae visit unless there is an issue.

B) all children go to pediatricians rather than a GP with specialists used for referrals. Pediatricians here even give shots (as my daughter’s does). Again, a ridiculous waste of money.  There is no reason why nurses and GPs can’t do much of the routine/easy medical visits.

This will require a change in attitude from the public who are used to the American approach to the use of specialists.

Where nurses are not suitably trained, could have different tiers of qualification. The BMA will fight this change because they want to ensure patients use them but it is unsustainable.

2) we should be using midwives employed by the hospital instead of gynae for routine obstetrics and delivery.

The overall point of this email is that we should be empowering medical professionals to be able to do more within their realm of skill; pushing routine tasks down the chain to the lower paid professionals. Consultants, of course, to be used as needed.

C13) I have been off-island and therefore unable to attend Allied Health related events relating to the Bermuda Health Plan. Naturally, as I am sure many of my colleagues, I too, was greatly concerned to see what little provision we have in the current GEHI plan as allied health professionals, was actually taken from us, not to be replaced with any other access to allied health services.

As the conversation is centered on reducing cost and making our healthcare more affordable feel this is an opportune time to commence a conversation centered on how the allied health professions can be central to making the effective change in healthcare reform the Government, regulators and insurance companies wish to achieve. I feel in order to achieve this much needed change in the cost of healthcare locally, a multi-factorial approach to increase the role of the allied health professions in required.

For too long the aspect of scope of practice in our profession has not been fully appreciated by the medical profession, insurance providers and regulatory bodies. Despite various conversations the subject has largely fallen on deaf ears. As a group, the allied health profession have integral roles in the delivery of healthcare across a large spectrum of specialities, all which can serve to reduce the cost of service provisions for all financial stakeholders, and most importantly improve the patient pathway experience. Furthermore with this said, allied health professionals should be afforded far greater allowance that what is currently present to allow greater access to our services, and increase our we capacity to provide greater value for money in the delivery of many services, not currently on offer to the Bermudian population.  Personally, I am most certain my colleagues in the allied health professions are committed to working towards a solution in respect to reaching the goals of providing affordable healthcare for all those that live in Bermuda. It is common practice, as health care providers for us to show empathetic understanding for those that require financial assistance to access our services. Quite often we heavily subsidize and discount or even remove co-payments for services for groups such as seniors and those in need.

Appreciate you taking the time to read this submission. If you have any questions please do not hesitate to reach out.

[Attachment]

If the Bermuda Health Plan proposal is to make health care more affordable, increase access to quality healthcare provision and reduce health related costs in Bermuda - Are we fully utilizing skill sets outside of primary care?

SCOPE OF PRACTICE

Across multiple jurisdictions, Allied Health professions have been at the core of increasing access to health care in both the primary and community sector. In many regions, the scope of practice for allied health professionals has seen an increase to provide more affordable options to the delivery of care normally delivered by medical professionals. The prompt for this change was to relieve pressure on hospital emergency access, primary care physicians and reduce associated health related costs for the delivery of the service.

The upskilling within traditional professions such as; physiotherapy, nursing, speech and language pathology, occupational therapy and dietetic nutrition has afforded allied health practitioners a greater scope of practice.

Many healthcare services have embraced the the expertise of physiotherapists with advanced/extended roles and reconfigured their services to incorporate physiotherapists and in turn other allied health professionals into patient management models working in collaboration with the medical team (Daker- White et al, 1999; Weale and Bannister, 1995, Rymaszewski et al, 2005). In the last three years membership of Extended Scope Practitioners/Advance Practitioners has more than doubled and includes members of other professions and from other countries.

The collective impacts of these national and international drivers have, however, been crucial to providing a greater emphasis for Allied Health Professionals to expand their scope of practice and to develop new models of service delivery that will improve access, choice and the clinical effectiveness of patient care, develop career structure and expand the roles of individual physiotherapists.

The transition to using allied health on the front lines of health care demonstrated marked improvement in key performance metrics such as greater access to care, reduced waiting lists, reduce healthcare costs in relation to the delivery of care and, most importantly overall improvement in the patient experience during the pathway and delivery of care.

At present, the scope of practice in Bermuda is restrictive for Allied Health professionals much to the detriment of the patient, and in a contributing factor in the rising cost of healthcare delivery due to a convoluted delivery of care provision in primary care. The Bermuda Health Plan proposal to restrict/ remove the allotted access to allied health care combined with the current restrictive scope of practice is cost prohibitive, and strikes at the very essence of the services we are ethically, morally and duty bound to serve and provide for the patient population.

Allied Health professionals in their respective fields are key practitioners utilized in the provision of autonomous care, direct access, preventive medicine, out patient and community services. Globally, allied health practitioners are essential service providers in many countries committed to delivering effective, accessible and affordable health care. A majority of allied health professionals, are committed practitioners whom work with a high level or moral and ethical integrity to deliver best practice care underpinned with evidence best medicine. As a collective our professional integrity is one of a more social and empathetic bias, with a desire to when possible offer equal access to services for those in need of financial assistance. We are supportive of healthcare reform, however the current proposal is not in keeping with either best practice nor evidence based delivery of care within the allied heath professions.

If an increase in the scope of practice for Allied Health professionals was to be in keeping with other regions facing similar challenges, Allied Health serve provision would be at the very centre of effective change to effectively reduce health care costs, prevention and the overall improvement for the patient pathway of care. The concept of allied health care professionals in the delivery of care has been in existence for 30 years. The idea of physiotherapists supporting orthopaedic services is not new and the concept was thought to be first reported in the United Kingdom (UK) by Byles and Ling (1989).

The aims of many extended/advanced practitioner role service provision have been outlined as follows:

  1. Reduce primary and secondary care waiting times;
  2. Improve access to emergency hospital based clinical investigations;
  3. Establish a comprehensive system of evaluating the management needs of patients with non- operative musculoskeletal conditions using commonly agreed protocols;
  4. Reduce the need for surgeons in the outpatient clinic and release them for greater operating time;
  5. Increase awareness of GPs and other healthcare providers of the appropriate use of orthopaedic clinics, physiotherapy and radiological resources;
  6. Improve communication between  departments;
  7. Improve quality of care of musculoskeletal care;
  8. Improve the professional image of physiotherapy and allied health professionals. (Byles and Ling, 1989; Van de Meene, 1988)

As it stands, restrictive scope of practice guidelines for Allied Health professionals coupled with the current Bermuda Health Plan proposal not to have any allied health provision or access to allied health related services out with the remit of BHB is short sighted, and flies in the face of best practice for current health care reform. If anything the conversation with the Bermuda Health Plan should be in providing greater access to care provided by allied health professionals, and improving the scope of practice within the allied health ranks.

Furthermore, currently the Bermuda healthcare model over-utilizes the hospital as a central point for the delivery of care for those unable to access services (HIP) or afford services in the private sector. The present model already has an increasing waiting list for outpatient related services, elective surgeries, diagnostic imaging and places pressures on healthcare providers to clinical effectiveness. Reducing the current access and allowance to such services provided by all the allied health professionals for Government civil service employees, and essential service providers such as fire, police and prison workers, their families and children will only serve to further increase waiting times, add further pressures on the standards and delivery of care provided to the patient. It has been proven in other regions, increasing waiting times are directly related to the overall cost of healthcare with associated secondary chronic illness and hospital admissions.

Accountability, value for money (VFM) and unique selling point (USP) are all watchwords in the health arena these days. It is our collective responsibility as clinicians, health insurance companies, regulators and hospital administrators to deliver VFM services, with right one, providing the right things, to the right people and in the right place.

A: Thank you for your interest in the Bermuda Health Plan and for your thoughtful submission.

In its discussion state, the mock plan for consultation did not include allied health services like physiotherapy, etc. However, the consultation process has highlighted this important omission and this will be revised.

After the public consultation is over, working groups will review the feedback and determine recommendations on what the proposed plan should include. Allied health has be raised as an important item to consider.

C12) I have been reading articles, have attended meetings and looked at the figures for how our health dollars are being spent. The problems that we have now will not disappear with a unitized system.

It seems to me that the real effort needs to be:

* be sure that the hospital is only for ACUTE CARE - not primary care visits and extended care. 60% of our costs going to the hospital is about 20% too much. I think we all know this but let's have the grit to tackle it. The hospital should NOT be      entirely government run. It should revert to a quango.

* a unitised system which requires, say, $550 plus, to be paid by everyone will still result in the same percentage of people who can’t afford it. If they can’t afford the present HIP or Future Care they won’t be able to afford any new plan

My very biggest concern is that there would be no competition for rates or services with a unitised plan. In fact, it will be worse than that as Governments have a track record of increasing costs (or new taxes - income tax???) with no consideration of what people really want. Sorry this is nothing personal at all and I fear that no matter what party would be in power. It’s just a bad thing. You have my 100% support to tackle the two big issues. That’s where the money is going down the drain. Please do the right thing and fix the problems.

C11) Stop this madness the people dont want it nobody can afford to pay $600+,or fight the rude staff at FA to get coverage

A: Your views are noted and will be taken into consideration as part of the consultation process.

C10) NO I don’t want a mandatory government insurance plan, when their current plans are woefully insufficient.  NO I don’t want to then pay for a supplemental private insurance, thereby paying for two insurances. NO many businesses will NOT pay for both government and private insurance. NO I don’t want added taxation to offset the cost of a government run healthcare. NO I don’t want a monopoly on healthcare thereby inevitably further reducing (already poor) quality due to NO demand. NO I don’t want struggling families to be crippled by this financial undertaking. NO this will not rectify current healthcare system malfunctions nor solves core issues.

A: Your views are noted and will be taken into consideration as part of the consultation process.

C9) [Edited to remove sensitive and identifying information]

Just a few thoughts. At a Health Fair, I met quite a few men with uncontrolled hypertension, and three likely new diabetes. There were a mix of uninsured unemployed, employed HIP, and a couple employed without HIP.......... yes, I know illegal but I dont think they will be complaining to BHEC. A few of the hypertensives were HIP- no medication budget.  The diabetics were uninsured. It felt pretty soul-destroying that the best advice I felt I could give them was to go and apply for financial assistance to hopefully be able to get HIP. Once they have HIP they can be referred into the hospital DREAM system, and maybe get a prescription budget on financial assistance. I have several FA patients who do have the latter, but I dont know eligibility rules. I also wonder if the PCMH at the hospital, would take them, or maybe ECP.

A big goal for any new plan moving forward has to be improving access for this group. I have not heard that the current BHP set up is really an improvement for them. The process of applying for financial assistance to get health insurance has major barriers for this group of people. First presenting yourself to the bureaucratic process of financial assistance office, and being able to explain that your application is chiefly for health care. From what I understand, you have to have an address to be eligible. I would imagine the whole process is also much easier if you have a phone number.  Next you have to get a doctor to sign 'the blue form'. That is another big step, to enter an established Doctors office, and also likely comes with fear of a bill. Doctors for their part, may be wary of signing these forms for people they have never met. Couple all this in with other major social/cultural and possibly psychiatric and addiction problems going on in their life, and it is stretch to think it ever happens.

The indigent clinic pre-dates my return to the island, so I cannot pretend to know all of the pros and cons of that situation. But I would have felt a lot more comfortable today if I could have pointed them in the direction of some kind of one-stop solution. Just a view from the ground for really looking for improvement moving forwards. 

A: Thank you so much for your thoughtful feedback.  There is much to say in response and an email may not suffice. If you would like to meet or speak on the phone, we can make ourselves available.

The challenges you describe for the uninsured and underinsured are fully acknowledged. Likewise, we realise that speedy solutions are necessary but challenging in the current system.

You may be pleased to know that the proposed reform (the "mock plan") includes funding for an ECP (which is also for the uninsured) with higher reimbursements as we know the piloted model got great results but had areas for improvement. The ECP continues to support existing patients on the programme but doesn't currently have funding to add more. We hope the reforms will enable us to add this as a priority.

The PCMH is still running and we are hoping to grow it over time. For now, contacting the programme directly may be the best way to try to assist patients in need.

Your feedback on the financial assistance process is also very helpful. We are making reforms and improvements in that area as well, though they are independent of the health reforms. We do want to improve eligibility criteria and improve the experience of those seeking or receiving assistance.

Thank you for your feedback. We appreciate you taking the time and do reach out if you would like to discuss further.

C8(i) In reading your information you have posted / hidden in the Health Council’s Website, your data is based on data from other countries.   Using this data is very skewed as it does not represent the patient population here, and will under address the medical needs.    I am referring to a study about transitioning to a universal model of health care that was done in Finland.    Finlanders are all Caucasian and are generally healthier than the Bermudian population.   There are also different genetics that are involved.    This model is not appropriate.

A: The data used for creating the benefits for consultation use Bermuda’s local population numbers as collected from local health insurers.  In a few cases where services are being proposed to be paid differently than insurers pay for them now, there are assumptions that are taken from relevant peer reviewed research literature.

C8(ii) It is clear that based on your statistic that 5,341, or 8%, of Bermudians are underinsured.    You are moving that needle to 100% of Bermudians under this plan.   The outcomes will be skewed.

A: 8% of Bermudians are uninsured, meaning they do not have any health insurance. Almost 1 in 4 people in Bermuda are estimated to be underinsured and this number is growing under our current health system.

C8(iii) Applying this plan boxes the entire population into a status quo of treatment and does not allow for new technologies or modes of treatment.   If something new comes out to treat a chronic disease, under this plan, you cannot take advantage of it – regardless of the outcomes and supporting data for the new treatment, because you are boxed in financially.   Your only option would be to pay out of pocket for either supplemental insurance, or pay cash for the treatment.   This is very bad for Bermudians.

A: One of the greatest threats to improving health outcomes is the lack of standards of care and evidence based ones.  Enhancing the core benefits does not stifle innovation but actually provides greater access to those types of new serves to the entire island

C8(iv) The people need to vote on this before it is implemented as law.  We do not feel that plunking numbers into a formula can substitute a relationship with our doctors and health care providers.   I can foresee that many who work in this industry will lose their jobs as physicians will be capped and unable to continue to pay salaries.   How will physicians afford to pay for supplies? – costs of goods and shipping continues to rise.    Wait times will be astronomical.    Overseas treatments will be only for the wealthy with the poorer patients having only the option of being treated on island.   If they need specialized services and there are no specialists in that field, the patient is just out of luck.   

A: Payments made to providers, such as physicians, will not be capped. As stated, we want to make the way that providers get paid easier while allowing them to have more time to provide care for their patients. Overseas treatment is being proposed to be included in the Bermuda Health Plan for all residents, which is not currently the case.

C8(v) I believe the government will end up regretting this move as it leaves them open to law suits when patients begin falling thru the cracks.   There are huge cracks and several chasms.   It is the wrong direction…..

A: The current system has created a number of gaps in care including not guaranteeing some coverage for prescription medications for all residents.  We are using this consultation period to identify those gaps and fill them.  This extends to areas such as mental healthcare, maternity care, allied health etc.

C8(vi) You should be moving more toward an EVIDENCE BASED payor system…..  This makes sense, and the savings would be astronomical.   This is how you satisfy the best of both worlds.   I have  a presenation on this that was I gave that I would be happy to present.  It is a more concrete move forward, it will save a significant amount of money, It will support and encourage outcomes, it keeps patients on their insurance, the government will see savings almost immediately, and it is backed by solid data that is appropo to this patient population – not some European nation that does not have demographics similar to ours.

A: We agree that evidence based medicine is a key way to improve our healthcare system. The use of clinical guidelines and being supported by decision support systems is important in improving our health and reducing unnecessary costs.  In addition, moving away from volume based payments to value based payments is a core principle of the new plan.

C8(vii) Please let me know if I may have an audience to present it.

A: We truly appreciate your questions and would love to meet with you to hear more of your ideas around evidence based care.

C7(i) Please can you  raise the amount for Futurecare prescriptions to at least  $1000. The proposed amount of $400 is unbearable for seniors.

A: The FutureCare $2,000 prescription cover will not be reduced. The BHP $400 for prescriptions will just be the base cover, which means FutureCare will either stay at $2,000 or it could be increased up to $2,400.

C7(ii) My husband and I are in our 80's  trying to stay as healthy as possible.   We are on statins and esomeprazole daily and occasionally Ciproflaxin. I receive $505 month for my pension and Future care costs are over $500 a month so that leaves me with zero. I have spent 60 years dedicated to this community / raised over 1 million $$$ for young Bermudians to train overseas and was the longest standing member of Tourism Board for 13 years.

A: The contribution to Bermuda of many seniors like yourself will not be ignored. These reforms will improve the base of FutureCare, hopefully, increasing primary care coverage and lowering co-pays. The final benefit package is not decided yet but the public consultation period is providing valuable feedback on what people need, which will inform working groups that will make recommendations.

C7(iii) First of all I must thank you for your reply which was not only so quick and so helpful but also kind and compassionate. It is certainly happy news that the Seniors prescription amount is not going to be reduced.   I think this has been misinterpreted by the media which, in turn, has given the proposed  Health Plan such concern throughout the  world of seniors. Perhaps this could be explained more clearly for Future Care recipients as it is most reassuring. Of course the Health Plan is going to be critical for Bermuda and most especially for seniors.  There is no doubt that with the fees that doctors are charging, Bermudians are reluctant to even make a doctor's visit. This is not helping the overall health of the community. Again I do thank you for your response and appreciate the task you are undertaking with the Health Plan.

A: Our efforts to improve the health system support our mission to make Bermuda healthier but feedback like yours is what keeps us going. You make a great suggestion and we will consider providing assurances to FutureCare policy holders in order to avoid the spread of misinformation. We encourage you to direct persons to our webpage to provide feedback about the proposed Bermuda Health Plan and to ask questions if they cannot find the information they are looking for. To that effect, we’ve created a another webpage so that the public can review all of the questions, comments and our responses at: www.gov.bm/health-plan-consultation-qa  

C6) To make a decision with a handful of people for a population of 60,000+ without FULLY KNOWING the consequences is ABSOLUTELY UNACCEPTABLE!!! There is no excuse for doing in a rush and without the VAST MAJORITY of population knowing the pros and cons. There MUST BE a MUCH BIGGER span of people to look at this from ALL angles-PROs and CONs. Without doing this is DICTATORSHIP.

A: We assure you that we’re consulting with the public about the Bermuda Health Plan. Decisions (with one exception highlighted below) have not been made and will be informed by the feedback that is received during the consultation period. To address your concerns:

The only decision that has been made, with feedback from key stakeholders, is the move from the current complicated payment system to a unified payment system for the core insurance plan. See our website at https://www.gov.bm/health-financing-reform-governance and the Stakeholder Group Consultation Report for more detail.

The Bermuda Health Plan will expand and replace the Standard Health Benefit (SHB). SHB has been mandated by legislation for the past 49 years. It is required to be included in every health policy and currently costs $355.31. This means that all insurance plans are comprised of the SHB + supplemental benefits. SHB covers care mostly in the hospital and lacks preventive services to keep us healthy. The reforms under consultation will shift some of the coverage from supplemental to core.

Consultation is open to the public to decide what should be included in a core health plan for all insured persons. Additionally we request that you consider the price at which you would pay for such services. The mock plan for discussion provides a starting point for expanding coverage at a $514 cost model. See the Consultation Guide for more detail at https://www.gov.bm/sites/default/files/Health%20Financing%20Reform%20Consultation%20Guide%20v1.3%20190930.pdf

Your suggestion for including a larger span of people is a great one. You may wish to check out the community discussions that are open to the public and the consultation meetings that have been held with stakeholders to date. It is important to note that discussions with stakeholders will continue after public consultation is closed.

C5) Having read though the various documents regarding the proposed reform of health financing in Bermuda, I would like to add some comments for your consideration. I have over 15 years experience working as a Health Economist (mainly in the pharmaceutical sector), and during this time I have directly observed the impact of health economic analyses on healthcare spending in many different countries. The issue of rising healthcare costs is affecting not only Bermuda, but all healthcare systems around the world. In a system with a limited budget it is critical that patients are receiving not only the most appropriate treatment but also that the treatment represents excellent value for the healthcare system. Many (if not most) publicly funded systems in the developed world make use of health economics to ensure that the care patients receive is not only effective, but also affordable. Health economists have developed a suite of tools to assist with the decision-making process when considering which treatments/procedures/pathways are the most appropriate. Making the costs and benefits explicit and comparable across interventions and disease areas ensures that the decisions are informed and therefore more likely to represent an efficient use of resources. It is my understanding that the goal of Bermuda’s healthcare reforms is to address rising costs, while improving both overall population health and individual health outcomes. I believe that incorporating a robust framework that incorporates the tools and analyses developed in the field of health economics would greatly assist with meeting these goals. If you have any questions about this, please do not hesitate to contact me.

A: The feedback you provided will certainly be taken into consideration as we endeavor to reform our health system. We would like to extend an invitation for you to participate in the Health Council's technical meetings. The meetings are heald three times a week on various topics. You can find the schedule here: https://docs.google.com/spreadsheets/d/1YLiaqequ9Tca-uH_RHNkWF9NP0IHwfP4dtMZcEGoSDw/edit#gid=1709744959

C4) We are urged to go to the doctor to prevent chronicle diseases. Doctors should be considered as one of the first steps to preventing. Please consider this in the plan and we would not need to go to the hospital.

A: You make a very important point and we agree that doctors are a very important part of prevention.

We would also add that the patient and other health practitioners play an important role as well.

We’re consulting with doctors and other health practitioners on the best way to offer more prevention services under the Bermuda Health Plan. These conversations are ongoing and will continue after the public consultation period has ended.

C3) As a citizen and Bermudian I am very concerned about the changes that this Government is proposing for the New Bermuda Health Care plan. If only 20 percent of the population don't have adequate health care insurance, why are those that do have 80 percent adequate coverage of the population being FORCED to change to something they DO NOT want changed? It makes more sense for this Government to focus on the 20 percent to lift their insurance to something more adequate and providing it for them only.  Also, to legislate that Insurance Companies cannot discriminate against those with pre existing conditions.  These are the issues we should be fixing. I think your plan is not good, because we will still need major medical and this means 2 health insurance plans and it will be twice the cost of what we are paying right now!  Our Health is something that we should be in control of not a Government.  If this is changed it will be a disaster for everyone not just 20% of the population.  Costs will be so much more, maybe double if Bermudians want Major Medical Insurance.  Employers won't want to split the costs and only want to provide basic insurance and employees if wanting major medical will be left paying for the access costs.  Everyone is thinking the same way. We already have 2 pension payments coming out of our pay, and now there will be two medicals as well?  I am just one voice, but everyone I have spoken to about this feels this Government needs to rethink this and scrap this plan ASAP. I believe if this Government wants to help those individuals that don't have adequate health insurance they should do so, not force those that do have adequate coverage to change to something they don't want. If these changes do come to pass, I believe Min Kim Wilson should work on the cost of lawyer fees  being lowered in Bermuda.  At present lawyers are charging between 500 to 600 dollars an hour which is ridiculous and highway robbery.  This is something that she would have a lot of influence over. I can justify paying this for my health but not for a lawyer, who in the end is the only one winning.  Sorry, for mentioning this, but if this Government wants to right injustices then the lawyer fees will need to be addressed next.

A: The health insurance policy that you currently hold includes a government mandated minimum of coverage called the Standard Health Benefit (SHB). This means that your insurance premium is comprised of the SHB premium (current cost is $355.31) + a premium for supplemental benefits. Right now the SHB covers mostly care in the hospital and lacks the prevention services to keep you healthy.

The Bermuda Health Plan is the core plan that will replace and expand the SHB. Consultation with the public is about what should be included in the expansion to more preventive care in the core plan that every insured person has. The reforms under consultation would shift some of the coverage from supplemental to core. The Bermuda Health Plan will regulate only the services that the people of Bermuda decide are important to include in the core plan.

The government does not intend to create a system that marginalizes one or more segments of the population. The legislation for the SHB was put in place to help to maintain the public health of the population.  Poor public health leads to all kinds of deterioration of the economy, social, and cultural structures.  Having disparities on what protections are afforded to the people of Bermuda is not only a health rights issue, but also has huge implications for the future of Bermuda. The purpose of the reforms is to assist Bermuda as a whole by creating more efficient risk pooling and a core plan that helps people stay healthy. The Consultation Guide has more information: https://www.gov.bm/sites/default/files/Health%20Financing%20Reform%20Consultation%20Guide%20v1.3%20190930.pdf

Employers currently cover supplemental benefits. This ability will not be changed by the reforms, however, how this will all work is part of the consultation process.

It is recommended that you address your concerns about lawyer fees to the Bermuda Bar Association.

C2(i) It is my strong belief that the general public should have the absolute right to determine their healthcare needs and method of paying for them.

A: Healthcare decisions and associated costs are not something that one bears on their own. Even now healthcare professionals stand in the gap to identify solutions to healthcare problems that arise.  In addition in regards to the cost of healthcare, there are two main structures that mitigate the impacts of ill health.  Those are health insurance and funding provided by the government. Neither of those funding sources come without rules or absolute discretion of the public to determine how that money is spent.  Less than 20% of healthcare spending actually comes in the form of out of pocket payments.  The notion that individuals make decisions on their health on their own is not represented in the structure of the system we all participate in.

C2(iii) No Government should be in the business of dictating to the taxpayers that they must either forgo their private healthcare plan or pay for both a Government mandated one as well as a supplementary private plan.

A: According to the WHO Constitution (1946) “…the highest attainable standard of health as a fundamental right of every human being.” Understanding health as a human right creates a legal obligation on states (governments) to ensure access to timely, acceptable, and affordable health care of appropriate quality as well as to providing for the underlying determinants of health, such as safe and potable water, sanitation, food, housing, health-related information and education, and gender equality.

For the last 49 years, the government of Bermuda has legislated the minimum benefits that must be made available to residents of Bermuda in what is called the Standard Health Benefit.  This legislation was put in place to help to maintain the public health of the population.  Poor public health leads to all kinds of deterioration of the economy, social, and cultural structures.  Having disparities on what protections are afforded to the people of Bermuda is not only a health rights issue, but also has huge implications for the future of Bermuda. Therefore, the representatives of the people, which are the elected governments, should absolutely have a say in the health system of a country for the public’s good.  With that said, and for clarification, there has been no proposal that individuals cannot maintain their private plans.   It is important however to put the proposal in context that currently you do not have the right to purchase any health insurance plan that does not include the benefits required to be provided to you by the government.

C2(iii) For those Bermudians who are satisfied with the service they receive from the private healthcare plans and are willing to personally pay for such, as thousands have done for decades, they should be free to continue. If the Government wishes to fund members of our society who cannot or will not pay for private healthcare, they should work solely on a sustainable plan for that minority of persons in the equation.

A: Government currently has a major role to play in your private health insurance.  There is no proposal being put forth to stifle consumer decisions on supplemental benefits in the same way that you would have discretion now.

C2(iv) The healthcare system is a complex one made more so by governments who believe they are capable of creating a system that verges on socialist engineering. It has failed so far in most countries in so far as the recipients are concerned. Long waiting lists for non-life threatening issues are not welcomed by many. It is known that thousands of Canadians cross the border yearly to pay for healthcare in the U.S. with average waiting time at up to 19 weeks.

A: Greater consolidation in healthcare has succeeded in good healthcare outcomes in the majority of countries.  These countries would not be considered socialist countries, in the same way that Canada, or the UK, or Australia or the State of Massachusetts are not run by socialist governments.  Healthcare is a fundamental building block of every society.  The concept that some Canadians cross the border to obtain services in the US is not an indication that healthcare in Canada is poor, as the people that fly overseas from the US to obtain healthcare in other countries does not indicate that healthcare in the US is poor.  These are consumer choices that free societies allow.

C2(v) Just as our personal health is PERSONAL, so should our right to pay for a program of medical attention that is provided by PRIVATE companies.

A: This right is not being taken from you in any form.

C2(vi) At the end of the day, I think I echo the concerns of thousands who are satisfied with our ability to work to earn the income necessary to afford, on a priority basis, the healthcare we desire.

A: In a capitalist society you can purchase goods that create satisfaction within the budgets you may have.  However, it would be illogical not to provide a semblance of equity in ability to achieve optimal health as everyone pays when public health is compromised.

C2(vii) Others in our society may prefer to see Government use our tax dollars to support their healthcare to a large degree, but I believe they will be in the minority. There are no free lunches.

A: The majority of Bermudian’s are at risk for health challenges.  Tax dollars are not being asked to pay for healthcare in any way beyond what they are being funded in subsidy currently. 

C1(i) Let us address a few easily modifiable CAUSES of poor health in Bermuda. What NOT to do: rather than shooting Bermuda in the foot, pushing healthcare providers to their tipping point creating shortage of healthcare providers as has happeed abroad, Mistake #! “copay cap" lowering payments to healthcare providers already struggling with rising to the roof costs of providing care, causing both financial & emotional burnout.

A: Regulation on copay has only been discussed on services that would be included in the Bermuda Health Plan (a redesigned Standard Health Benefit). As you may know now, services under Standard Health Benefit are currently not allowed to charge a co-pay at all.

C1(ii) Mistake #2 mandated EMR —> consumes 2.5 hours for every 1 hour paper chart work —> EMR is #! cause of healthcare worker burnout: cutting down # of patient care hours, changing career / leaving healthcare for another unrelated career / retiring early ——> EMR agrivation is now the #1 cause of healthcare worker burnout & healthcare shortage at this time (since 2014 in USA)

A: While EMRs may have their cons, there are also plenty of pros that practices in Bermuda are finding extremely helpful for supporting patient care.

C1(iii) Mistake #3 healthcare employers & employees have voiced their agrivations with BHeC activities. Ignoring employer & employees who at the same time, receive welcoming recruitment offers from other beautiful less onerously regulated communities, BHeC would foolishly CREATE a healthcare shortage in Bermuda.

A: There is healthcare regulation within every jurisdiction. Having effective regulation is not the cause of healthcare shortages.

C1(iv) What to do: 1) Herbicide & surfactant sprays (particularly ‘glyphosates') have been recently proven to cause cancers, especially Non-Hodgkins Lymphomas. Why spray, as the roadsides must STILL be cleared of foliage; why not just CUT green & CLEAR more often, providing unemployed pesons IN NEED of income with earned funds for health insurance? ==> STOP all gov’t spraying immediately!!! Spare us cancers AND employ hustle truck, prison half-way, &/or unemployed persons in need of health care funding to weed wack & clear roadsides. Bermuda Gov’t Works & Engineering sprays all our roadsides, including our public children’s playground Somerset Long Bay Park, TCD tag # HA 267 / driver [Name redacted] (photo 22 Aug 19) How many children & adults walked & were exposed to carcinogens here between when toxic spray was delivered here & the colour change happened? Why has govn’t not posted flags to "KEEP OFF sprayed" areas? Lets not poison Bermudian children & Bermuda like this at all. Let's keep those $$ in Bermuda instead of sending $$ abroad to toxic chemical companies? Let’s stop buying & importing herbicide/ surfactant spray completely. Let’s cut healthy green foliage from the roadsides. Let’s assure Bermuda water lenses are clear of herbicide & surfactant ( i called Monsanto in 2009, NO studies have shown safety of spraying over underlying drinking water lenses. Once IN water the toxicity does NOT break down NO safety has been shown for wind blowing wet herbicide-surfactant product at the time it is sprayed until it dries; dry particulate product could? re-aerololise, wind blown onto roof-tops, then wash with rain into drinking water tanks & lenses.

A: Your concern has been forwarded to the Department of Health who would be the ones to look into environmental variables.

C1(v) 2) Alcohol is toxic to EVERY body tissue it touches; and at 7 calories / per gram (= per milliliter = only 40 drops) alcohol is THE major contributor to obesity & diabetes in Bermuda Alcohol is toxic to EVERYTHING it touches, lips to anus & all body tissues & fluids in between… alcohol harms myocardial conduction tissues causing arrythmias requiring pacemaker placements, etc etc. ==> RAISE TAXES & BOTTLE DEPOSITS on all alcohols & mixers / sodas sold for consumption MASSIVELY & ENOUGH to cover both this would encourage roadside alcohol bottle litter clean-up AND this would help cover ALL diabetes & fatty-alcohol liver health care costs that alcohol consumption causes in Bermuda. ??? Have taxes on alcohol gone up AS MUCH & ENOUG to pay for the ALL the DAMAGE alcohol does, including domestic violence & fractured families due to alcoholism? vs. payroll taxes paid by healthcare providers / employers has risen 19% since 2016, vs. Health Insurance costs went up 8% January 2019, Why not be fair & make those who create the damage by CHOOSING to purchase alcoholPAY for the damage alcohol does to their own bodies and our community health?

A: Your concern has been forwarded to the Ministry of Health and Ministry of Finance who can link health and taxation. As scientists, we agree that there is a detrimental effect of alcohol on the cells of the body.

C1(vi) 3) Rather than contine gifting Big corporate utility & telecom DUTY FREE import on chronic inflammatory disease & cancer causing dirty electricity producing petroleum-burning electicity generators; Let’s see Government instead incentivise healthy hydro sources of electricity. Let’s see government mandate transfer of OWMERSHIP TO our electric company’s very intelligent employees, and get rid of the shareholders taking $$$ from our electric utility system. Employee owned & co-op electric utilities are proven much lower cost and run cleaner & healthier for the communities they serve. Instead of gifting telecom companies DUTY FREE importation of antennaes & gear to erect WHO carcinogenic radiation-emitting telecom antennas / towers / gear for Netflix streaming, instead, LET”S SEE GOVERNMENT incentivise HEALTHY FIBER OPTIC CABLE for all, especially in schools, as France did to protect children from WHO carcinogenic wireless electronic device radiation. Consider offering HEATHCARE PROVIDERS & EMPLOYYERS duty free allowances on surgical supplies to cut out cancers; syringes, needles, cotton balls, procedure chairs & tables etc etc. to TREAT the health issues these dirty electricity & RF radiation imports cause EVERY health care employer has paid duty, warfage, shipping, on all health care supplies, to date, there has been NO DUTY FREE allowances EVER for private health care providers. How DARE government mandate private pension, collect Land Tax on our work places, SI, Payroll tax on our employees, annual company registry fees, duty on EVERY THING, & then DARE to PRESUME to set copay caps to choke our ability to meet these legal mandates ????

A: Your concern has been forwarded to the government on the preference to use cleaner sources of energy.

C1(vii) 4) How DARE gov’t post anti-Copay Publicity on the back of buses? This is absolutely out of line, it vilifies health care providers who actually provide gratis care to whomever voices or is known to have challanges with copays !!! ====> STOP all negative publicity toward healthcare providers immediately!  If government fails to properly consider & care for those who provide healthcare, everyone loses. The back of the bus propaganda is emotionally negative & abusive toward healthcare providers with good hearts & great care, and deserving of the pay they dearly earn. If government crosses the line in the sand, pushes healthcare providers to the tipping point of emotional burnout, or financial insolvency through copay capping, then tell me please what is a healthcare provider /employer to do to make up the shortfall created by government’s malalaigned capping of copays ??? Short our deserving hard working health care employees? No. Costs of providing healthcare are already financially to the roof & emotionally at a tipping point for healthcare providers, both employers & employed. These are tipping points for burning out for Bermuda’s best, most experienced, most effective & MOST  EFFICIENT healthcare providers. These are non-negotiable lines in the sand for Bermuda’s most loved & appreciated healthcare providers. Once wise elder healthcare providers are lost to other communities, they are not coming back. New, young healthcare providers want “work: life balance” simple employment rather than endure the massive financial & emotional marathon of establishing & running a best community service, a most needed efficiently run private surgery with a HUGE risk of burn out, rising to meet every challange every step of the way every day. What incentives has government laid out to attract bright young Bermudians into healthcare? Seeing “How am i going to manage my copay” propaganda on the back of buses vilifies those who care most, great healthcare providers are sent an emotional message that they are un-appreciated, and financially threatened here in our own home community. Young persons who might have felt a calling to healthcare may chose to do something else seeing how government treats care providers so poorly with negative propaganda on the back of buses. Help me to understand please, what was supposed to be the point of this? Who thought of this? Until government thinks of healthcare providers as individuals with compassion & unless our govennment CARES FOR our health care providers, we ALL lose. Is this an understandable, good place to start? Government now must repair this emotional damage to healthcare providers, both present & FUTURE. Healthcare providers give their whole hearts & souls to taking care of our Bermudian community one by one, hour after hour, day after day with great consideration & kindness & care. Burn out rate & risk has never been higher. Pushing healthcare providers to burn out…. EVERYONE loses.

A: The bus ads have been removed. There are common complaints that are made by the public and providers in regards to the size of some copays.

C1(viii) 5) Instead of taking aim at & driving present & future health providers out of & away from Bermuda, Perhaps consider a solution of caring, love, and compassion, invite the needy to your own dinner table, with love & compassion? Will it work to put the 30% uninsured & underinsured persons on the same health care plan that our elected MPs enjoy? Will this work as a solution to the problem prompting the back of the bus propaganda? p.s. MANDATE KEMH HOSPITALISTS must COMMUNICATE first WITH their patient’s GPs & allow the pt’s GP to determine what specialist if any would be best for the patient to see & when. MANDATE THAT AN EMAIL BE SENT TO GPs OF PATIENTS when ADMITTED TO & DISCHARGED FROM KEMH. HOSPITALISTS SHOULD NOT BE CALLING SPECIALISTS FOR simple incidental common ISSUES JUST BEFORE DISCHARGING A PATIENT HOMME FROM KEMH, DEMANDING the SPECIALIST SEE THE PATIENT FOR the incidental MINOR COMMON ISSUES, which THE GP normally HANDLES efficiently & effectively with great knowledge & skill beyond that of the hospitalist.

A: Government employees are on GEHI. Your perspectives on GPs and communication with the hospital will be shared.

 

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