Bermuda’s Aging Health System Dr. Ricky Brathwaite, Senior Health Economist 27 th July 2016
Overview Who are we What do we know What is the health system puzzle Questions
Who are we? The Health Council Quasi-Autonomous Non-Governmental Organisation (QUANGO) Established by Bermuda Health Council Act 2004. Operational since 2006. Structure: Council (Board) has 15 members Secretariat has 8 employed staff Mission: To regulate, coordinate and enhance the delivery of health services Vision: To achieve a quality, equitable and sustainable health system
What do we know? Healthcare in Bermuda is not affordable for all Relative low income threshold for 2013 was $51,012 Our chronic disease burden is significant and our aged population is growing 13% Diabetes compared to 8.3% globally Trends demonstrate growth in healthcare costs and expenditures over time Subsidies have more than doubled since 2005 The international standard of health financing has encouraged greater collaboration within new financing models The current Standard Health Benefit package has the potential to limit choice and competition Our population is aging, with an average age now of 51 years old
The Average Age of the Population Increased by 11 Percent over a 10-year span 2015 Claims Experience by Age $12,000,000.00 $10,000,000.00 $8,000,000.00 $6,000,000.00 $4,000,000.00 $2,000,000.00 $- 0 20 40 60 80 100 120 2000 → 2010
Ageing population
Population Health Only 8% of the $2.4M of Cancer treatment dollars were spent on island Cancer is the leading cause of $12,000,000.00 death in Bermuda $10,000,000.00 Diabetes ranks in the top 5 of Heart Diseases and leading causes of death in $8,000,000.00 Cerebrovascular Diseases Bermuda have high death rates In the U.S., people with $6,000,000.00 diagnosed diabetes, on $4,000,000.00 average, have medical expenditures approximately $2,000,000.00 2.3 times higher than what expenditures would be in the $- Cancer Treatment Heart Disease Diabetes absence of diabetes Local Overseas Heart Disease can lead to strokes and other disabling Claims for Diagnosed complications Mental Health Disorders Diabetes were 5 times rank in the top 5 higher than Cancer
35% of adults have at least 1 chronic health condition Excludes hypertension and high cholesterol. If these are included then 50% of adults have at least one chronic condition Source: Health Disparities Report 2013
Diabetes prevalence
Population Expenditure Trends $13,000 $11,000 $9,000 $7,000 $5,000 2007 2008 2009 2010 2011 2012 2013 2014 Per Capita Health Sys. Expenditure (BD$)
Health Expenditure & Life Expectancy $6,993 Health expenditure per person (PPP adjusted (USD))
Determinants of Health Outcomes Bermuda Hospitals Board Ministry of Health Overseas Care Local Practitioners Prescription Drugs Other Administration Health Determinants 7% 7% 7% 7% 8% 8% 9% 10% 8% 8% 9% 9% 9% 9% 9% 11% 7% 7% 8% 7% 6% 7% 6% 6% 18% Behaviors 15% 13% 15% 12% 14% 29% 16% 17% 11% Social Circumstances Environment 10% 14% 14% 13% 15% 13% 14% Genetics 13% 16% Medical Care 6% 7% 6% 7% 6% 8% 18% 6% 20% 6% Stress 5% 44% 43% 43% 44% 43% 42% 41% 39% Source: McGovern et al. (2014) US Spends less than 9% on Prevention 2007 2008 2009 2010 2011 2012 2013 2014
What is Bermuda’s Health System Puzzle CARE DELIVERY SHB HEALTH SYSTEM FINANCING IMPROVEMENTS
Current Health Financing System Repayments RESIDENTS Government Taxes Employers Consolidated Fund Funding Premium Individuals Standard Premium Rate Funding Funding DOH Grant Grant INSURERS Out of pocket payments (e.g . copays) GEHI Claims Reimb. Argus Financial HIP LCCA Assistance BNTB BF&M Premiums FutureCare Veterans Fund HSBC Colonial Transfer Premium Funding Claims Claims Reinsurance Mutual Reinsurance Fund Claims & Out of pocket payments PROVIDERS KEMH Patient Care Subsidies Local Providers Claims NOTES: Overseas Hospitals 1. Insurers light = SHB MWI dark = supplemental benefits. 2. Excludes Public Health Services and Residential Care Homes Version 4 – 05 Nov 2015
Health Insurance Coverage – SPR
Financing Impacts Consumer Costs Services covered SUPPLEMENTAL BENEFITS Private Insurers (& Approved Schemes) $450 – $1,700 Future Care $504.21 HIP $433.31 HOSPITALIZATION AND HOSPITAL RELATED SERVICES Standard Health Benefit $338.07 (& Mutual Reinsurance Fund) Adapted from Population covered WHO 2010
In Bermuda ranks just below the US in total health sector size relative to GDP
Healthcare Subsidies Other Subsidies 7% Geriatric Subsidy 9% Clinical Drugs Subsidy 2% Indigent Subsidy 5% Aged Subsidy (-2.0%) Aged Subsidy Youth Subsidy 61% Youth Subsidy (+11.9%) 16% Indigent Subsidy (+45.3%) CCU/Geriatric Subsidy (-4.0%) Clinical Drugs Subsidy (no change) Other Subsidies (e.g., Haemodialysis) (-6.5%)
Evolving Payment and Delivery System Models Performance Based Financing Local Providers KEMH LTC Providers Care Delivery Private MWI Public Overseas DOH Clinics Hospitals
Opportunities for Improvement System fragmentation in financing and care Lack of coverage for some Limited coordination of care Inconsistencies in care strategies Decreases in available subsidy funding Standard Health Benefit limitations in service categories and providers
Bermuda Health Action Plan Hypertension Diabetes Heart disease Asthma Chronic kidney disease Other NCDs
Questions
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