June 15, 2012Dear Sir,Re: National Health Plan: Bermuda’s Health System Reform Strategy. The Steering Committee of the National Health Plan (NHP) would be grateful for space in your Letters to the Editor to provide a snapshot of some of the progress made on reforming Bermuda’s health system. It is important to understand why we need to reform. Firstly, Bermuda’s health costs are among the highest in the world, second only to the US. In 2010 we spent $9,734 per capita, which is about twice the OECD average after adjusting for cost of living. Health costs are increasing faster than inflation and show no signs of slowing down on their own.Secondly, despite this high level of health spending, Bermuda doesn’t achieve the outcomes in health or access that other developed countries achieve with significantly less spending. We spend about nine percent of GDP on health — similar to the OECD average. But most of those countries have better life expectancy and provide health coverage to 100 percent of their population. So it is clear that if we went to control costs and improve health we will have to make some changes. We went to keep the things that work, and fix the things that are causing high costs and low value for money. This requires addressing some fundamental problems in our health system, to ensure it can be affordable and sustainable, while delivering high quality.The National Health Plan was finalised in November 2011 after much consultation. Six Task Groups and a Steering Committee were set up to develop ways to implement the reforms. The Task Groups are made up of a wide range of community members. There are over 70 individuals representing healthcare, insurance, business, civil society, and patient and public advocacy. There is more information about the groups on the NHP web site at www.nhp.bm. The Plan has an ambitious time frame that aims to see core reforms implemented in 2014, namely:1. To improve the benefits in the minimum package of insurance mandated by law (this is currently the “Standard Hospital Benefit”; its price is determined by actuaries and approved by Government annually — in 2012 it has been set at $271.61 per month).2. To ensure all Bermuda residents are covered for this basic package.3. To ensure the package is affordable and stays in line with inflation.To date, benefit package opinions have been drafted with the input of health professionals and insurers, and actuaries are in the process of pricing them. In addition, the financial modelling to assess the cost under a reformed system is being developed. There will be more public consultation when this work is ready. In the meantime, we want to give stakeholders clarity on two fundamental facts:1. The National Health Plan will not create a nationalised health system. The NHP intends that healthcare will be delivered by a range of providers; doctors, dentists and other professionals will continue to be primarily private businesses. The public will continue to have choice in their healthcare provider.2. Insurance coverage beyond the minimum package will continue to be provided by private insurance companies.What is being restructured by the NHP is the minimum benefit package, its content, organisation, cost and financing. Various options are being explored to ensure the package is organised and financed in the most cost-effective way possible. This will be good for people, business and the economy. We encourage the public to visit the NHP web site at www.nhp.bm for further information and invite them to contact the Ministry of Health with any queries. Your sincerely,Steering CommitteeFor the National Health Plan