Bermudas Aging Health System Dr. Ricky Brathwaite, Senior Health - - PowerPoint PPT Presentation

Bermuda’s Aging Health System

• Dr. Ricky Brathwaite, Senior Health Economist

27th 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

$- $2,000,000.00 $4,000,000.00 $6,000,000.00 $8,000,000.00 $10,000,000.00 $12,000,000.00 20 40 60 80 100 120

2015 Claims Experience by Age

2000 → 2010

Ageing population

Population Health

• Cancer is the leading cause of

death in Bermuda

• Diabetes ranks in the top 5 of

leading causes of death in Bermuda

• In the U.S., people with

diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes

• Heart Disease can lead to

strokes and other disabling complications

Only 8% of the $2.4M of Cancer treatment dollars were spent on island Claims for Diagnosed Diabetes were 5 times higher than Cancer

$- $2,000,000.00 $4,000,000.00 $6,000,000.00 $8,000,000.00 $10,000,000.00 $12,000,000.00 Cancer Treatment Heart Disease Diabetes Local Overseas

Heart Diseases and Cerebrovascular Diseases have high death rates Mental Health Disorders rank in the top 5

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

$5,000 $7,000 $9,000 $11,000 $13,000

2007 2008 2009 2010 2011 2012 2013 2014

Per Capita Health Sys. Expenditure (BD$)

Health Expenditure & Life Expectancy

Health expenditure per person (PPP adjusted (USD))

$6,993

Determinants of Health Outcomes

41% 43% 39% 42% 43% 44% 44% 43% 6% 7% 6% 8% 7% 6% 6% 6% 13% 13% 16% 15% 14% 13% 14% 14% 17% 15% 16% 15% 13% 14% 12% 11% 8% 7% 7% 7% 6% 7% 6% 6% 8% 8% 9% 9% 9% 9% 9% 11% 7% 7% 7% 7% 8% 8% 9% 10%

2007 2008 2009 2010 2011 2012 2013 2014

Bermuda Hospitals Board Ministry of Health Overseas Care Local Practitioners Prescription Drugs Other Administration

29% 20% 5% 18% 10% 18%

Health Determinants

Behaviors Social Circumstances Environment Genetics Medical Care Stress

Source: McGovern et al. (2014) US Spends less than 9% on Prevention

What is Bermuda’s Health System Puzzle

CARE DELIVERY HEALTH FINANCING SYSTEM IMPROVEMENTS SHB

PROVIDERS INSURERS

Current Health Financing System

Employers Individuals Government Consolidated Fund

Patient Care Subsidies

Argus BF&M Colonial

Mutual Reinsurance Fund

Local Providers Overseas Hospitals

KEMH MWI

LCCA

FutureCare HIP

Taxes Transfer Out of pocket payments (e.g . copays) Claims Claims Claims Veterans Fund Premiums Financial Assistance Funding Funding Grant Grant Funding Funding

Premium Repayments NOTES:

• 1. Insurers light = SHB

dark = supplemental benefits.

• 2. Excludes Public Health Services

and Residential Care Homes

Claims & Out of pocket payments

GEHI BNTB HSBC

Version 4 – 05 Nov 2015

Premium DOH

Standard Premium Rate Claims Reimb.

Reinsurance

RESIDENTS

Health Insurance Coverage – SPR

HOSPITALIZATION AND HOSPITAL RELATED SERVICES Standard Health Benefit $338.07 (& Mutual Reinsurance Fund) SUPPLEMENTAL BENEFITS Private Insurers (& Approved Schemes)

$450 – $1,700

Services covered

Population covered

Future Care $504.21

HIP

$433.31

Adapted from WHO 2010

Financing Impacts Consumer Costs

In Bermuda ranks just below the US in total health sector size relative to GDP

Healthcare Subsidies

Aged Subsidy 61% Youth Subsidy 16% Indigent Subsidy 5% Clinical Drugs Subsidy 2% Geriatric Subsidy 9% Other Subsidies 7%

 Aged Subsidy (-2.0%)  Youth Subsidy (+11.9%)  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

Public KEMH MWI DOH Clinics Private Local Providers LTC Providers Overseas Hospitals

Care Delivery

Performance Based Financing

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

Chronic kidney disease Asthma Diabetes Hypertension Heart disease Other NCDs

Questions