Core questions remain in the Bermuda Government’s long journey to universal health coverage, health minister Kim Wilson told The Royal Gazette — in particular, paying for it.

“How we are going to pay for it, we have not even got to that yet,” she said.

The question of financing one the Progressive Labour Party’s “fundamental objectives” is not new.

Ms Wilson told legislators in February 2022 that the cost remained to be calculated.

In an interview last Friday, she said that the Covid-19 pandemic meant that “developing our principles had to pause almost three years”.

However, Ms Wilson outlined pending legislation giving great powers to the Bermuda Health Council to track overused health services, and a timeline leading to an April 2025 phased implementation of the core benefits package for universal healthcare.

A “clinical senate” is now tasked with laying out the core benefits, which should be defined by next April.

It is hoped to come up with payment model options by April 2024. Ms Wilson said more people would have to be taken on board to help shape the governance structure of universal health coverage.

“I do not think we will have challenges, but we do have to recruit,” she said.

Key legislation is pending to allow the Bermuda Health Council to collect details on what health services are being used the most to enable the regulation of “the cost of certain copays for the vulnerable”.

“The legislation will allow data to be collected so the health council will be able to ascertain how much utilisation there is at this particular facility for this particular service.”

The BHeC at present cannot get access to such a level of detail, Ms Wilson said — and “overutilisation does increase our costs”.

She said the release of a national digital health strategy would also realise savings, from erroneous duplications of service to patients “shopping around” from doctor to doctor.

“We will then have a digital structure so that a doctor can know they have just had a scan and there is no need to do another one.”

Medical practitioners will deliver more efficient care, compared with an industry that still uses fax machines to send information from practice to practice.

Patients will eventually have access to their own medical records through a digital portal, Ms Wilson said.

“The more we use the system, the more the cost of healthcare.

“Our premiums are based primarily on how much we use as well as the types of technology we use.

“A blood test may cost $20; a scan will cost more money. Utilisation is what drives up costs.”

Still to come is the merging of the Government Employee Health Insurance plan with separate plans under the Health Insurance Department, which manages the Health Insurance Plan and FutureCare.

Ms Wilson added: “This doesn’t mean that GEHI will turn into HIP and vice versa. But we create economies of scale through efficiencies by having all government plans amalgamated into a larger pool.”

HIP clients also stand to get a prescription drug benefit covering 100 per cent of costs up to $1,000 in any policy year; while FutureCare clients will get an increase from $2,000 to $3,000 for prescription drug benefits.

Ms Wilson noted that there was one feature of universal healthcare’s core benefits package that had already been agreed upon.

“It will include primary care and preventive care, which is critical.”

Securing access to annual check-ups for the general population is aimed at warding off delayed diagnosis and lessening chronic illness, such as diabetes and kidney disease.

“If you delay, you find out you have a diagnosis that could have been picked up two years prior.”

The clinical senate has “unanimously identified that preventive primary care has to be in that package.”

Ms Wilson also emphasised that getting secure financing for the island’s hospitals had no bearing on delivering universal healthcare.

“One has nothing to do with the other,” she said.

She said the aim was for patients to seek “more preventive and primary care, and not at the hospital, which is for acute and emergency care”.

While Bermuda Hospitals Board highlighted a $16 million shortfall in its government allocation back in March, the Government has committed to covering the rest of the grant that was agreed upon in 2019.

Ms Wilson added that staffing shortages in healthcare, which she raised last month in the House of Assembly, had hit nursing staff particularly hard, but were also seen in posts such as physiotherapy and occupational therapy.

“It’s something we are seeing worldwide,” she said.

Efforts such as the Dr Barbara Ball public health scholarship and promoting career options within public health were aimed at courting more Bermudians into the field.

Ms Wilson confirmed that the attraction of other countries for newly qualified healthcare workers posed another difficulty.

“Bermuda has to compete with other jurisdictions,” she said. “In America, they are offering them green cards to work.”

Ultimately, Ms Wilson said the community had the power to strengthen Bermuda’s healthcare — beyond refraining from burdening King Edward VII Memorial Hospital by going to the emergency room to duck copays from going to their GP.

“I want to add that if we’re saying utilisation is driving up healthcare costs, that means we can all assist, by maintaining a healthy lifestyle,” she said.

“All that is critically important.”