Bermuda Doctors Association On Health Reform

[Updated] The “unified model would not lower healthcare cost without negatively impacting the quality of care and waiting times of services,” the Bermuda Medical Doctors Association said, adding that they have concerns about the “short time frame which the Government is proposing to implement these changes, and have challenged them to reconsider extending it.”

Bermuda Medical Doctors Association President Dr. Henry Dowling said, “The Bermuda Medical Doctors Association [BMDA] has been asked to put forward its comments and opinions regarding the Ministry of Health’s radical proposal for a complete overhaul of our healthcare model to a more socialized system of health, similar to those found in Canada and England.

“Like those systems, the Bermuda Health Plan has described itself as seeking equity in healthcare and wanting to achieve universal healthcare through moving the funding of our health under a single government controlled system. They have written and verbalized the ability to bring down the cost of healthcare using this model, and through it finding ways of helping Bermudians become healthier within this new model.

“Since the majority of physicians had not been given any more information about the new plan than the public, we sought out as much Information from local stakeholders, as well as those in countries that had already transitioned to a similar healthcare model. What we found caused us concern.

“Last week, the BMDA shared its data collection process at our first Physician Summit, bringing a wide cross section of physicians, dentists and other providers of healthcare to hear from the Ministry. After the presentations, the physicians debated all the different proposed changes presented, and worked to a consensus on how we would be able to produce a public statement, which would represent our feelings and concerns.

“The following is a summary of the results of the conversations held:

• “All felt that the mechanism for consultation used by the Ministry was not adequate nor robust enough to truly evaluate the impacts the unified system could have on Bermuda, prior to it being ‘formalised’ by Government.

• “There is an inherent and grave danger with the single payer [government] financing model. Volatility in the cost of an aging population could place financial burdens on the single government system which will force them to cut services, or raise prices, both options will hurt Bermudian’s access to local and overseas services.

• “Bahamas has undertaken similar healthcare reform, and their experience is enlightening. An official that helped to initiate their reform confirmed the need for a clear financing structure to be in place prior to planning any dramatic changes or income taxes would have to be imposed to make up the shortfall.

• “There was unanimous agreement that the unified model would not lower healthcare cost, without negatively impacting the quality of care and waiting times of services.

• “There was some interest in whether a unified system could improve primary care access, and whether a capitated funding mechanism could facilitate easier access to primary care services, but the physicians once again unanimously agreed that there needed to be more robust data provided before we could stand behind either of these for our patients.

• “We have great concerns on the very short time frame which the Government is proposing to implement these changes, and have challenged them to reconsider extending it and not putting any legislation forward next year that will advance such a rapid move towards socialized healthcare.

• “The Physician body felt that several key historic missteps leading to some of our current issues such as rising healthcare costs, lack of GPs within the hospital, and the lack of coordination of care in the island could have been avoided if the Ministry would allow a representative of the BMDA onto key health organizations such as the Bermuda Health Council, the Bermuda Medical Council, and the Bermuda Hospital Board, all of which are currently seeded by the desires of the Ministry of the day, versus the insight of the needs of the people.

“It was encouraging to see the Bermuda First report on Health, commissioned by the Premier himself, also have similar concerns with the negative impact a unified financing structure could have on our community. These included highly subsidised care, high taxes, rationed care, and a well defined two tiered health system, based upon socioeconomics.

“We have begun putting a group of physicians together who will create a white paper that will lay out a more in depth analysis of the healthcare dilemma.”

Update 5.18pm: Health Minister Kim Wilson said, “The Ministry of Health remains fully committed to continuing the dialogue with physicians and other healthcare providers on health financing reform, as well as with all other health system stakeholders. Discussions are ongoing and there is increased appreciation that they represent meaningful dialogue to build solutions together.

“The Bermuda Medical Doctors’ Association [BMDA] statement reported in the media reflects both the shared interest in putting patients first, and the mutual desire to continue dialogue.

“The Ministry has been made aware of BMDA’s position with respect to the Government’s decision to adopt a unified model of health financing. Their concerns are important and will inform the consultation and development of a transition roadmap to phase reforms gradually and avoid unintended consequences.”

The Ministry added, “A BMDA representative was appointed to the Health Financing Reform Stakeholder Consultation Group in September 2018.

“On appointment all representatives in the Group received information on the task and were invited to access more information, meetings and presentations to explain the options and gather their constituents feedback and views.

“As described in the Health Financing Stakeholder Consultation Group Report, four meeting were held with the large Group plus another four with individual stakeholders between September and October 2018.

“The Ministry of Health is aware that BMDA invited physicians to participate in a survey to get their feedback on the questions posed. Six physicians responded to the survey.

“The Ministry of Health included notices and stories of the health financing reform consultation in its quarterly Vital Signs Newsletters which is sent to stakeholders, including physicians, in September 2018 and December 2018. All stories referred readers to the information on the Ministry of Health web pages.

“In December 2018 the draft report was shared with the Stakeholder Consultation Group for their comment and input. Subsequently, the report was finalized and published in August 2019.”

“The Health Financing Stakeholder Consultation Group Report can be found at www.gov.bm/healthplan.”

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