By Catherine Kempe, OBA Candidate for Devonshire North West
If 2020 is the year of the pandemic, then 2019 was the year of healthcare reform debates and legislative changes. Let’s review what happened in 2019 as the changes that took place are still being felt today.
Prior to 2019, Standard Health Benefits (SHB) (the minimum government legislated coverage) included:
- The majority of services at Bermuda Hospitals Board
- A handful of services at private entities as approved by the Bermuda Health Council (BHeC), such as MRI, CT scans, ultrasounds and home healthcare
- The Mutual Reinsurance fund (MRF), which prior to 2019 covered only items such as dialysis, kidney transplant and medications for antirejection for those who had a kidney transplant.
For 2018-2019 the MRF was $101.97 of each standard policy, but as of June 1, 2019 it went up to $331.07 and the PLP government passed a law that the MRF is now called a “premium”, rather than the tax that it is. Insurance companies are required to pay this “premium” to government within 30 days of services delivered at the hospital, no longer giving insurance companies leeway to extend payment plans or extend coverage if its customers are having a rough spell. These changes were made on the assumptions that BHB had a massive surplus of funds, and services wouldn’t suffer. This was false. What has been experienced by patients is longer wait times for MRI and CT scans at the hospital and cancellation of surgeries due to the hospital trying to meet its budget.
Now most people wouldn’t worry about this, except for the fact that during COVID-19, as of July 2020, the Hospital actually used $2.7Million of the charitable donations to the COVID-19 fund from local companies to purchase PPE and other equipment. If they had this amazing surplus then why are they using funds that we the public thought were to assist the people of this country, during the COVID-19 economic hardships. By changing how the hospital is funded, the hospital was no longer able to raise the capital through insurance billing, covering its basic needs and the cost of the new Acute Care Wing. The Bermuda Hotel Association pleaded with Premier Burt in May 2020, seeking relief in their rate of the MRF, but government would and could not, as reducing these charges would cause a disadvantage for the hospital to provide care. In other words, it would not have enough money to run its operations.
This was not the only change that the Government was trying to push. The PLP government wanted to charge ahead with changing the healthcare system we have, to a unified payer system. They held town hall meetings where Bermudians asked questions like: what this would cover and what this would cost, and no firm answers were given. Their plan was based on an actuarial report from 2012 that indicated, in order to afford a National Health Plan in Bermuda, additional revenues besides the premiums would be needed in order to afford it. Additional revenues that would come from increasing land tax, pay roll tax, and taking from the contributory pension fund. The patients and doctors were not happy with what government proposed and over 12,000 people signed the petition to relook at it. The PLP Government refused.
I think it is important to interject here, that a universal healthcare coverage plan is not exclusive to, or necessitates, a unified payer system. It requires a system to have complete data on the numbers of insured, under-insured and uninsured; employed, under-employed and unemployed.
But in 2020, with the onset of COVID-19, the plans for healthcare reform went silent, that is until on the Daily Hour Show of September 9, 2020 Dr. Ricky Braithwaite, CEO of the BHeC, announced that they are reconsidering their healthcare plan changes. Stop the presses… so what happened in this last year? During their COVID-19 press conferences, Minister Wilson touted, without evidence, how much better it would have been if they had their unified system. They ignored the majority of physicians and healthcare stakeholders, that had been asking for real data, saying that they can’t agree blindly with the changes being proposed, and that it wasn’t going to fix the majority of the underlying cost problems at hand. Still, the PLP government were determined to push it through, so what changed since then… Is the pausing of their plan just an election ploy to appease the 12,000+ people that signed the petition against the changes?
Healthcare is too important to play around with. After rent or mortgage, it is the leading cost for most families. Yes, changes need to be made to it, and the OBA supports reform towards the goal of a universal healthcare coverage system; but reforming the overall healthcare system in Bermuda isn’t only achieved by looking at healthcare. Changes in education and population affect the usage and its costs. It’s a change that must be looked at very closely before implementing anything that would fail to deliver what it promises and be very costly to reverse.