The cost of healthcare in Bermuda is one of the highest in the world relative to economic output, according to the latest figures.

The National Health Accounts Report 2013 also indicates a rising tide of uninsured Bermudians.

And although Bermuda spends more of its gross domestic product (GDP) on healthcare than all but two countries, our life expectancy is actually lower than many who spend less.

The information was discussed by vice president of BF&M Insurance Group Holly Flook RN, BSN, who argues that healthcare consumers can be the strongest agents for change.

The insurance executive highlighted the issues in a keynote address to Chartered Professional Accountants recently and then further outlined her thinking to The Royal Gazette.

The sombre news includes survey results estimating the rise in respondents who said they had no health insurance, which climbed from six percent to eight percent, year over year to 2012.

In fact, the report concludes: “It is beyond the scope of the National Health Accounts to discuss the impact of such changes on the health status of the population. However, some of the changes, such as reduced insured headcount, may have repercussions on health status.”

The report further stated: “In (fiscal year ending) 2012, health expenditure as a percentage of nominal GDP increased from 11.8 percent to 12.2 percent.

“The persistently high expenditure on health, despite the decline in nominal GDP, indicates the relative resilience of health expenditure to changes in economic conditions.

“In particular, given that Bermuda’s share of health expenditure to GDP is high compared to OECD (Organisation for Economic Co-operation and Development) countries, and that Bermuda’s health expenditure per person is high relative to life expectancy, it will be an important challenge for the country to control this trend while maintaining quality of care and quality of life.”

Ms Flook’s primary responsibility at BF&M is for oversight and management of Group Life, Group Disability and Group/Individual Health products.

She believes that Bermuda can arrest the trend, including with more education and better lifestyle choices. A reduction in substance abuse, more exercise and better diet control would be a start.

The report also indicates, somewhat surprisingly, that while health insurance was the major source of paying for healthcare, it accounted for only 53-56 percent in the years 2006 to 2012.

Health insurance includes health claims paid by all of Bermuda’s insurers: four private health insurance companies, the Health Insurance Department (for the Health Insurance Plan (HIP) and FutureCare), three Approved Schemes (employer-funded plans including the Government Employees Health Insurance (GEHI); and the Mutual Re-insurance Fund.

A further 28-32 percent was paid by the public sector.

Public sector financing represents: direct financing of health promotion and prevention; financing of public health services and primary care provided by the Department of Health; grants and subsidies for secondary care; health administration financing by the Ministry of Health; funding for the Health Insurance Department administration and FutureCare; and, financing of the various grants to non-profit organisations.

In addition, individual out-of-pocket financing fluctuated from 15 to 12 percent for the period. This includes co-payments, self-financing amounts for uninsured individuals, and full out-of-pocket payments to practitioners and providers for uninsured health related services.

Ms Flook stated: “The healthcare consumer is impacted by how efficiently or effectively the system functions. The healthcare consumer can be the single most powerful piece to the healthcare puzzle because healthcare consumers have the power to impact prevalence and severity of disease, need and mix of services, drive market product offerings, and affect a government’s policy focus.

“There is a growing trend of healthcare consumerism fuelled by two way access to tools and technology. This environment means individuals are armed with current information and are empowered.

“Many years ago healthcare was hallmarked by passive participation. Today, individuals have the ability to actively participate in their care plan, and in choosing how their healthcare will be financed and how services will be utilised.”

The National Health Accounts report also outlined: “In the public subsector the most significant component of expenditure was the Bermuda Hospitals Board for the operation of the Island’s single hospital system.

“On average, from 2006 to 2012, the BHB absorbed 42 percent of the Island’s health expenditure. The BHB was also the largest component of total health expenditure during the period. In the fiscal year ending 2012, some 48 percent of the BHB revenue came from Government.

“However, the BHB revenue does not reflect all health services provided at BHB. Due to a Memorandum of Understanding (MOU) that capped the amount of claims that BHB could recover for the year, the $16 million that exceeded the revenue cap was deducted from the BHB revenue.

“As a result, the amount of health expenditure at BHB presented in this report excludes the ‘Revenue Cap Allowance’, ie the $16 million that exceeded the revenue cap. Had the MOU not been in place, total health expenditure would have increased two percent from the previous year.

“The most significant component of private health expenditure was overseas care. In 2012, overseas care expenditure totalled $89.9 million or 13 percent of total health expenditure.

“The majority of overseas care expenditure was on inpatient and outpatient care from overseas hospitals, totalling 60 percent of overseas health expenditure in 2012. The rest of overseas care spending comprises of fees paid for services such as overseas physicians, dentists and other categories of healthcare providers, overseas prescription drugs, overseas diagnostic imaging and laboratory, and hotel and transportation costs.”