Health Council ‘Increasing Necessary Oversight’

May 29, 2018

The Bermuda Health Council is continuing its mission “to ensure that everyone in Bermuda can access healthcare without significant financial loss.”

A spokesperson said, “Health insurance costs in Bermuda today range from approximately $5,200 to $21,600 per person per year. If you are at the bottom of this scale or have no insurance coverage at all, chances are you will not be able to access sufficient healthcare.

“Sadly, this is even more likely to be the case when you or your family members are sick and need it most. The Bermuda Health Council’s [the Council] greatest challenge is how to protect members of the public from finding themselves in this all too common situation. One of the ways we do so is by looking at the degree to which your health insurance premiums provide coverage for appropriate health services.

“When the Council issues licenses to health insurers and approved schemes, we check how much money they make [loss ratios] from health insurance premiums and require them to report information on a quarterly basis. This creates an opportunity to ensure your healthcare dollars are being spent on appropriate care.

“The Council also enforces the Claims Regulations which is legislation that requires health insurers to pay providers in a timely manner so that providers can provide care to their patients.

“In 2017, there was improvement in how quickly insurers are paying providers to deliver health services as compared with 2016. However, certain physicians, dentists, and allied health professionals expressed concerns about not being adequately reimbursed by insurers for the services they provide.

“Further, health service providers are not always made aware of what health services insurers reimburse and in what amount. Insured persons would benefit from increased transparency to make information available about the cost of care and what is reimbursed by insurers.

“As the Council reviews health insurance on the island, we are leading efforts to reform the way we pay for care and what we pay for. Within this context, the Council strongly advises health insurers and approved schemes to reimburse for appropriate health services that are needed by the community; have a transparent pricing scheme so that people have information about out of pocket costs; pay providers on time and according to best practice standards so that health outcomes improve; and provide better and more useful coverage for essential health services.

“Health insurer licensing fees significantly increased this year to assist with increasing necessary oversight and regulation to address these issues. Moving forward, we are requiring more frequent data submissions to more closely monitor claims reimbursement and developing guidance about how we pay for health services.

“As the Health Council continues its mission to ensure that everyone in Bermuda can access healthcare without significant financial loss, we will continue to track the money we pay to ensure it is applied to making all people of Bermuda healthy.”

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