Life expectancy rose, cancer mortality declined, but over the last decade Bermuda’s spending on healthcare grew and grew.When it comes to expenditure, the Island is second only to the US, the top spender of the Organisation for Economic Cooperation and Development.Bermuda’s latest National Health Accounts report, which came out over the summer, showed the Island spending $670 million on health for the 2011 fiscal year. That figure was projected to reach $1.7 billion come 2021 — a lot more than the Island can afford.The hospital facility now being built is the most visible sign of changes afoot but behind the scenes — with the impending National Health Plan as well as recent legislation on generic drugs and upfront payments — the Island’s stakeholders are pedalling in a furious effort to bring down the price of health.Hospital construction remains on target for 2014.“Today’s medical care issues are not the same as they were 30 years ago and new issues will develop and evolve in the coming decades,” a spokeswoman for the Bermuda Hospitals Board told The Royal Gazette. “The hospital is being built now to include adaptability in recognising the pace of technological change in the future.”Keeping pace with demand, updating equipment and cutting down on Bermuda’s overseas healthcare spending — which last year neared the $100 million mark — made the new hospital an imperative.The public-private partnership is the first of its kind for Bermuda and the biggest capital project.It saw the consortium Paget Health Services sign on the dotted line with BHB in December 2010.Asked for an update, BHB said the last main roof slab had been poured; work has shifted to internal construction.“Two architects are now on site to coordinate detailed designs and the internal finishing works,” the spokeswoman said. “Early in 2013, crews will be working on air conditioning, commissioning the elevators and ensuring the building is functioning properly.”Reforms at KEMH have been another top priority for BHB and Government.A three-year survey of patient satisfaction has shown a consistent rise, while the group Accreditation Canada has put the hospital on par with Canada’s top 20 percent.The construction has similarly risen in public favour: the 2006 announcement that a new hospital could be built in the middle of the Botanical Gardens ignited a furious backlash.Simultaneously, the closure of the Medical Clinic brought protesters out in droves in 2007. The Opposition One Bermuda Alliance has promised to revive it.Public anger over the loss of the clinic was somewhat mollified by the opening of the Lamb Foggo Urgent Care Unit in 2009.Recent controversy for BHB has centred on its administration: the OBA has pressed Government throughout this year to release the salary figures for upper echelon hospital management.Revealing the wages is a legal requirement, the OBA said. Health Minister Zane DeSilva responded that reporting of wages remains the same as it was when the Progressive Labour Party took government in 1998: a lump sum.The issue was rekindled when KEMH chief of staff Donald Thompson was placed on administrative leave this summer and ultimately resigned. The moves prompted demands for open information from patient advocacy groups as well as the Opposition.The Bermuda Healthcare Advocacy Group is one organisation that has repeatedly accused BHB of a lack of transparency.A review of BHB by consultants Howard Associates is anticipated early next year.Touching again on the issue of costs, this year marked a shake-up for how local service providers and insurers do business.The Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 2012 brought an end to patients being asked to pay upfront for the insured portion of their treatment. It also forced reforms in how the two sides — insurers and service providers — communicate with one another.And the approval this year of the Pharmacy and Poisons Amendment Act sought to pull down medicine costs, by giving the green light for Bermuda to import drugs from any country in the world if the medicine is sold in the US, Canada or EU member states.Generic drugs stand to cut Bermuda’s spending significantly: the latest Throne Speech pledged to approve them for cover under Government Health Insurance.On the matter of insurance, virtually nothing has generated as much talk and political acrimony as the FutureCare programme for seniors, implemented in 2009.Bermuda’s version of the US’s Medicare is subsidised by the Government: a low-cost scheme to deliver comprehensive care to the elderly — an issue of increasing urgency as the Island’s senior population steadily increases.Initially the Opposition worried that FutureCare was being rushed through the House of Assembly; the two sides of the House have clashed repeatedly on the topic virtually ever since.In the build-up to the election, as the two parties spar on the question of Government spending, and cuts to the same, the OBA has insisted that it would not change the benefits offered under FutureCare.Probably the cornerstone of the current Government’s promise when it comes to healthcare in Bermuda is the pledge of universal access, on which the National Health Plan is based.Launching its debate in the House in February of last year, Mr DeSilva summed up what was at stake.He said: “It is unacceptable that, although we spend more on healthcare than almost any other developed country, we cannot provide an adequate level of coverage to all Bermudians.”The NHP, which aims to deliver basic healthcare to 100 percent of residents next year, is also expected to usher in sweeping changes to healthcare — although much of its specifics are yet to be revealed.At the bottom of it all is the national health: the Well Bermuda national health strategy was launched in 2006 with an aim to effecting lifestyle change.The message from Government is that the best way to control costs is to live healthily, Mr DeSilva has said: “If we can become healthier as a community, then the whole community will benefit.”