Dr J Attride-StirlingChief Executive Officer2nd February 2010

BHeC ROTARY PRESENTATION

Overview

Who we are

What we do

Why we do it

BHeC: Who we are

Quasi-Autonomous Non-Governmental Organisation (QUANGO)

Established by Bermuda Health Council Act 2004. Operational since 2006.

Mission: to regulate, coordinate and enhance the delivery of health services

BHeC: Who we are (…cont’d)

Healthcare users

Annual MOH Grant $1.3 million

Structure: Council (Board) has 15

members Secretariat has 8

employed staff

Vision: Working together for a sustainable healthcare system

BHeC: What we do

Find out more at www.bhec.bm

BHeC’s Strategic Plan

Core operational activities

License health insurers

Review Standard Hospital Benefit (minimum insurance package) & Standard Premium (SHB price) annually

Review regulated provider fees

Enhance regulatory framework for healthcare

Enhance coordination of healthcare stakeholders

BHeC: Why we do it?

Why: Sustainability

Key assumptionsWHO health system modelBermuda’s health systemValue for money

Assumption 1: Health as a human right“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services…” Universal Declaration of Human Rights, Article 25(1)

Illustration taken from “We Are All Born Free”, Amnesty International (2008) An illustrated children’s Universal Declaration of Human Rights.

Assumption 2: Healthcare is unlike consumer goods

Market forces don’t follow the same rules for healthcare

Healthcare interventions are provider-driven

Patients ability to shop-around is skewed

OECD Financing & Equity

Systems based on individual premia usually more responsive, but larger

burden on high-risk, high-use groups, usually the sick and the poor, leading to financial barriers to access

Systems based on ability to pay more equitable financial impact and

access to care, but less responsive to patient needs

Stewardship

Financing

Generating Resources

Delivering Services

Health Outcomes

Responsiveness

Fair financialcontribution

WHO Health System: Functions Goals

Source: WHO (2003)

Professionals per 10k:International comparisons (2007)

334515Singapore

656525UK

8129022Canada

988424USA

1377224Bermuda

Pharmacists (per 10,000)

Dentists (per 10,000)

Nurses (per 10,000)

Physicians (per 10,000)

Technology:International comparisons 2007

18.714.4Switzerland

12.76.7Canada

34.326USA

3131Bermuda

CAT Scans(per 1,000,000)

MRI units(per 1,000,000)

Health Indicators: Some international comparisons

14

8

7

11

0

Maternal Mortality (2007)

2.1 (2nd)

4.8(32nd)

5 (36th)

6.2 (46th)

1.3 (1st)

Child Mortality (2007)

80.6 ( th)

79.1 (30th)

80.7 ( 8th)

78.1 (35th)

78.3 (36th)

Life Expectancy

at birth (2007)

Singapore

UK

Canada

USA

Bermuda

Financing: Sources (2007)

100446,910Total

51.83.5

15.670.9

231,80315,65169,721

317,215

Private sector (est.)InsuranceNon-profitHousehold financingTotal

27.91.1

29.0

124,7424,993

129,735

Public sectorConsolidated fundOtherTotal

%BDA$ (000)

OECD average: 70% Public and 30% Private

Financing: Expenditure (2007)

100446,910Total

271096

52

119,68243,94640,06526,550

230,283

Private sector (est.)Local providersOverseasDrugs and others suppliesInsurance administrationTotal

74148

29,533187,134

216,667

Public sectorMinistry of HealthBermuda Hospitals BoardTotal

%BDA$ (000)

Financing: Share of GDP (2007)

7.6Health share of GDP (%)

6,982Per capita health expenditure (BDA$)

5,855,379GDP (BDA$000)

446,910 (est.)

Health expenditure (BDA$ 000)

2007

Per Capita Healthcare Expenditure and Health Share of GDP (2007)

Per Capita Health Expenditure and Share of GDP

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

USABerm

uda*

Norway

Switzerl

and

Luxe

mbourg

Canada

Netherlan

dsAus

triaFranc

eBelg

iumGerm

any

Denmark

Irelan

dSwed

en

Iceland

Austra

lia

United King

domFinl

and

Greece

Italy

Spain

Japa

n

New Zealan

dKore

a

Czech

Rep

ublic

Slovak R

epub

licHung

aryPola

ndPort

ugal

Mexico

Turkey

Perc

ent o

f GDP

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Per

Capi

ta E

xpen

ditu

re

Per Capita Health Exp. Health Exp Share of GDP

Bermuda: Per capita health exp. = PPP US$6,982 (est.)

Health share of GDP = 7.6%

Life Expectancy and Per Capita Health Expenditure – OECD (2007)

Health Expenditure &

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

USABerm

uda*

Norway

Switzerl

and

Luxe

mbourg

Canad

aNeth

erlan

dsAus

triaFran

ceBelg

iumGerm

any

Denmark

Irelan

dSwed

en

Icelan

dAus

tralia

United

King

dom

Finlan

dGree

ce Italy

Spain

Japa

nNew

Zealan

dKore

a

Czech

Rep

ublic

Slovak

Rep

ublic

Hunga

ryPola

ndPort

ugal

Mexico

Turkey

Hea

lth E

xpen

ditu

re (P

PP)

66.0

68.0

70.0

72.0

74.0

76.0

78.0

80.0

82.0

84.0

Life

Exe

ctan

cy

Per Capita Health Expenditure (PPP in $US) 2007 Life Expectancy at Birth (years) 2007

Per Capita Health Expenditure in Bermuda Relative to Income (1993 - 2007)

4.8 3.35.06.7

7.27.6 2.84.67.3

10.013.9

19.9

0

5

10

15

20

25

VI V IV III II I

Inco me bracket ( V I = lo w; I = hig h)

%

1993

2007

Low Income

High Income

Healthcare expenditure and income

Take-home messages

Healthcare is a right, not a commodity

The way in which a health system is structured impacts on its cost

Bermuda can get more bang for every healthcare buck

Vision and collaboration are needed to get us there

Thank you!

Any questions?

Visit www.bhec.bm for more information