Cost has become a priority for all stakeholders in Bermuda’s healthcare system.For a sample of top health concerns across the community, The Royal Gazette started with the Bermuda Medical Students Society.Diverse factors drive up the expense for a community like Bermuda, according to BMSS chairman Asha Ratteray.“Healthcare cost is rising for many different reasons,” she said. “Population ageing has risen in recent years in developed countries; a phenomenon in which the percentage of elderly people in a population increases. These individuals who usually suffer from chronic illness require more medical care.“Advancing medical techniques, equipment and specialised personnel increase the quality as well as the cost of medical care.”She added: “Aside from this, medical training is expensive as well, the cost of training a doctor increases upwards from $150,000.”Part of BMSS’s mission is to keep Bermuda’s talent at home. The organisation has a particular stake in developing mentorship through its Adopt a Medical Student initiative.The group, which comprises medical students and is overseen by practising physicians, is to send out applications to local doctors over the coming week to pair them up with students and “facilitate a relationship between the two”.The group’s aim is to cultivate the natural fraternity in the medical community, and it is especially active through social media such as Facebook.Part of the imperative for home-grown mentorship is reflected by the courting of Bermudian specialists such as cardiologists, to return home and thereby cut down on overseas spending.For insurers of healthcare, such as John Wight, CEO of BF&M, the bottom line is “effective and efficient care delivery”.“In order for a health system to achieve this state the following points must be considered,” he said. “Bermuda must improve upon how we leverage technology and partnerships to produce greater system efficiencies with a focus on long- and short-term quality health outcomes.“Following on this, our system must manage unnecessary costs to the system by monitoring and acting on overutilisation and incidences of fraud. We must ensure all providers of medical services, public and private, function in an environment of transparency especially around cost of services versus billed charges.”Finally, he added: “We must support lifestyle choices that drive preventive health activities up and overall costs down over time.”Concurrent with costs, Bermuda’s recession is the unifying determinant for stakeholders.For the Bermuda Health Council, tasked with a sweeping mandate to regulate the Island’s health services, the economic climate has led the group to delay taking on its mandated authority for the registration or licensing of service providers on the Island.A BHC spokesman directed The Royal Gazette to the group’s website, which states that “the current economy and resource limitations across the health system have led us to revisit priorities, and health service provider licensing has been placed on hold”.Cost containment is the council’s present focus.This includes “controlling the entry of high-cost medical equipment; and collaborating with professional bodies to develop standards of practice to address issues like healthcare quality and self-referrals”, the spokesman said.Seniors have been much in the news as the PLP and OBA wrangle over the FutureCare insurance system for pensioners.Like the ever-increasing cost of healthcare, the steady rise of the Island’s elderly population is part of a worldwide phenomenon, but no less alarming for it: the latest Throne Speech noted that Bermuda’s seniors are projected to become one-quarter of the population by 2030.Seniors advocate Claudette Fleming of Age Concern said the cost of prescription drugs and insurance premiums were top-priority concerns.By example, explained Ms Fleming: “For second-phase subscribers to FutureCare, premiums are in excess of $600. According to the 2010 Census, the median annual pension reached $15,606 for persons receiving pensions aged 55 years and older.“If we consider that current FutureCare premiums are $7,620 annually, the pensioner whose sole income is $15,606 or below is left with only $7,986 dollars or less per year to survive in today’s economy.”And of course, private healthcare premiums are much higher, she added.“There is also the issue of prescription drug coverage of $2000 for non-generic brands. We are coming into contact with more and more people whose $2,000 [the spending cap on FutureCare] is running out within nine or more months, so they are having to find ways to make up the coverage they would normally have.”Just last week, Ms Fleming said, Age Concern encountered a senior whose medication is $4,000 per month — and yet he isn’t eligible for Financial Assistance.“It’s mind-blowing any way that you proportion it, whether it be a public or personal responsibility,” she said. “Healthcare in Bermuda is frighteningly expensive.”Heading off those runaway costs is the most urgent priority behind Government’s National Health Plan.Ms Fleming said her group’s big hope for the NHP was to see health costs reined in by a stern look at “abuse and misuse of healthcare dollars” — in addition to determining less costly community-based alternatives to the provision of care.“We must also look at the investment that we are making in wellness and prevention, which must start as early in life as possible in order to get the absolute best results in the future,” she said.“There are simply no quick-fix answers.”