Health Minister Zane DeSilva issued a robust response to Opposition criticism on his portfolio contained in the Budget Reply yesterday.A statement sent to the media on his behalf defended the initiative to cap spending on the hospital subsidy and questioned the One Bermuda Alliance’s criticism.“It is unprecedented, I’m sure, for anyone to criticise legitimate efforts to control health costs while maintaining quality care. The Opposition may not believe that we can work with the hospital to cap costs but our actuarial analyses reveal otherwise,” the Minister said.“We know this is doable and we are doing it now.”The Minister’s statement explained that budgeting for the hospital was difficult and uncertain because Government paid all claims submitted to it by the Bermuda Hospitals Board.“Under this old system, due to this uncertainty, Government established a base budget in the near certainty one or more large supplementaries would be required.“In the current economic climate, both Government and BHB want to work together to control unnecessary utilisation and bring a higher level of certainty to the budgeting process. This will be a fairer process. The financial risks will be more evenly shared between Government and BHB, he said.“Internationally, it is common to share financial risk more fairly between payers and hospitals across the system. This will all be detailed in a Memorandum of Understanding (MOU) between Government and BHB, which will make it very clear what the financial cap is that represents the maximum Government will pay. MOUs already exist with certain private insurers and they have worked very well, without impacting the quality of or access to appropriate care.”On the question of what happens if the money runs out, Mr DeSilva’s statement said that BHB will absorb the costs if demand exceeds the cap“It will make BHB both focus on appropriate care, and monitor usage carefully throughout the year, whilst carefully controlling its own costs.”And he assured the public that patients will not be turned away“This Government will never turn its back on its people.”The statement continued: “There will be no need to ration care. MOUs are already in place with some private insurers and this has not resulted in rationing care.“BHB will ensure that the appropriate level of care is provided to every patient. This is what quality healthcare is about”.But the statement added that patients had a role to play as well.“We tend to think more testing, more drugs and more treatments equal better healthcare and this is simply not so. We need to ask is this test really necessary? Is this drug essential? BHB will ensure clinical quality through clear clinical pathways for different illnesses to standardise care and ensure appropriate steps are taken for every patient.“Additionally, people should carefully consider whether to use Emergency, or whether they can see their primary care physician. Visiting Emergency is much more expensive as it is geared to care for acutely ill patients.”Decisions will continue to be made by patients, families and physicians, the Minister said, answering another of the OBA’s questions.And the Minister assured the OBA that the MOU will be made public once finalised.On whether the cap regime would impact insurance premiums, the Minister said:“The BHB has been capped for utilisation with private insurers since last year, after piloting the system with one private insurer the year before.“This has enabled us to keep insurance premiums down by containing the Standard Premium Rate. Because this cap on health premiums has worked well, we have extended it to the subsidy budget.”On private sector consultation, the Minister said that “there is no reason to question whether the private sector would agree to containing health costs.”The Minister also assured the public that Government will continue “to do everything possible to care for seniors in need, and the health budget reflects this” and that FutureCare will continue.“I am absolutely confident that the measures being taken across the health system are serving to contain health costs. The Ministry is working closely with the Bermuda Hospitals Board, the Bermuda Health Council and the private sector to ease the financial burden of health costs on individuals, families and employers,” Minister DeSilva said.“The National Health Plan demonstrates the medium and long-term strategic direction for health reforms.“Through the Health Plan we will create a fair, affordable and financially sustainable health system for all of Bermuda’s people.”