Health in Bermuda

Last updated

Kim Wilson is the minister of health in Bermuda. [1]

Contents

The Bermuda Hospitals Board operates the King Edward VII Memorial Hospital, located in Paget Parish, and the Mid-Atlantic Wellness Institute, located in Devonshire Parish. [2] Boston's Lahey Medical Center has an established visiting specialists program on the island which provides Bermudians and expats with access to specialists regularly on the island.[ citation needed ] There were about 6,000 hospital admissions, 30,000 emergency department attendances and 6,300 outpatient procedures in 2017. [3]

The Bermuda Hospitals Board operates the King Edward VII Memorial Hospital, located in Paget Parish, and the Mid-Atlantic Wellness Institute, located in Devonshire Parish.

Paget Parish parish of Bermuda

Paget Parish is one of the nine parishes of Bermuda. It is named for William Paget, 4th Baron Paget de Beaudesert (1572–1629).

Devonshire Parish parish of Bermuda

Devonshire Parish is one of the nine parishes of Bermuda. Originally named "Cavendish Tribe" and later "Devonshire Tribe. It is named for William Cavendish, 1st Earl of Devonshire (1552–1626). He had never visited Bermuda himself, despite a parish being named after him. Devonshire Redoubt, on Castle Island, one of the Castle Harbour fortifications of St. George's Parish, was also named after him.

Unlike the other territories that still remain under British rule, Bermuda does not have national healthcare. Employers must provide a healthcare plan and pay for up to 50% of the cost for each employee. [4] Healthcare is a mandatory requirement and is expensive, even with the help provided by employers, though no more expensive than that which an employee in the US would typically pay for healthcare when obtained through their employer[ citation needed ] and the coverage typically far exceeds that which one may have through their employer in the US[ citation needed ]. There are only a few approved healthcare providers that offer insurance to Bermudians. [4] In 2016 these were the Bermudan government's Health Insurance Department, three other approved licensed health insurance companies, and three approved health insurance schemes (provided by the Bermudan government for its employees and by two banks). [5]

National health insurance (NHI) – sometimes called statutory health insurance (SHI) – is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or Statutory health insurance does not equate to government-run or government-financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system, the UK's National Health Service, and the South Korea’s National Health Insurance Corporation contributions to the system are made via general taxation and therefore are not optional even though use of the health system it finances is. In practice, most people paying for NHI will join it. Where the NHI involves a choice of multiple insurance funds, the rates of contributions may vary and the person has to choose which insurance fund to belong to.

Primary Care

Primary care in Bermuda is provided by a range of private providers. These range in size from small, individual practices, to large multi-doctor practices. The Primary Care Physicians have a variety of training - many of them have specialist qualifications, such as Membership of the Royal College of General Practitioners from the UK, or have completely Family Medicine internships and residencies and passed board exams in the US or Canada. However, there is at this time no regulation, and many physicians working in Primary Care have no specific postgraduate training. In general, physicians who have had sufficient training and are driven by patient care will follow clear guidelines for care, but there is no requirement for Primary Care Physicians to do so at this time. Because there is little regulation, some practices are able to have extensive diagnostic and imaging practices, and some even self-refer to consultants they bring onto the island from overseas, or have even hired physicians to work in primary care just in order to be able to make referrals to specialists. There are regulations that clearly state the Primary Care Physicians must bill directly to the insurance providers what they will pay. However, the remuneration doesn't always cover the cost of the office visit, and in those instances there will be a co-pay. The co-pay is not regulated, and can vary significantly between primary care providers (and changes each year depending on the insurance companies and inflation). All of this can make navigating Primary Care in Bermuda a difficult process. Physicians should freely declare their postgraduate qualifications and any conflicts of interest they may have, so that the public are able to make a more informed choice.

Staffing

There are no paramedics on the island. The Bermuda Hospitals Board says that they were not vital in Bermuda because of its small size. [6] Nurse practitioners on the island, of which there are not many, can be granted authority to write prescriptions “under the authority of a medical practitioner”. [7]

Paramedic healthcare professional who works in emergency medical situations

A paramedic is a specialist healthcare professional who responds to emergency calls for medical help outside of a hospital. Paramedics mainly work as part of the emergency medical services (EMS), most often in ambulances. The scope of practice of a paramedic varies among countries, but generally includes autonomous decision making around the emergency care of patients.

Nurse practitioner profession

A nurse practitioner (NP) is an advanced practice registered nurse (APRN) classified as a mid-level practitioner. A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion, but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions. According to the American Association of Nurse Practitioners, a nurse practitioner is educated at the masters or doctoral level to provide "primary, acute, chronic, and specialty care to patients of all ages and all walks of life". The scope of practice for a nurse practitioner is defined by jurisdiction. Depending on jurisdiction, nurse practitioners may or may not be required to practice under the supervision of a physician. In United States, nurse practitioners have been lobbying for independent practice. The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact. The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training. Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals.

Fees

The Bermuda Health Council produces a fee schedule for providers of Standard Health Benefit and advises the government on health issues. [8]

Coding

Bermuda uses the ICD-9 diagnostic coding system. It plans, however, to switch to the more comprehensive ICD-10 system to align with the US (which switched in 2015), since Bermudan residents most commonly obtain overseas healthcare there. [9] Bermuda does not have Stark laws, nor do they have self-referral guidelines or anti-kickback laws. The lack of regulation in healthcare, specifically with billing and reimbursement, makes healthcare in Bermuda quite lucrative for physicians and owners of medical/healthcare practices.

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Work on ICD-10 began in 1983, became endorsed by the Forty-third World Health Assembly in 1990, and was first used by member states in 1994.

Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services ("DHS") if the physician has a financial relationship with that entity.

Related Research Articles

Emergency medicine medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for unscheduled and undifferentiated patients of all ages. As first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units, but may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, ultrasonography, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine.

In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers on a prepaid basis. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider's contracted status.

General practitioner type of medical doctor specialising as a generalist, usually working in primary care setting

In the medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.

Health care Prevention of disease and promotion of wellbeing

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Primary care day-to-day health care given by a health care provider

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a nurse practitioner, or a physician assistant. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or a Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Clinic Health care facility, primarily focused on the care of outpatients

A clinic is a healthcare facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary healthcare needs of populations in local communities, in contrast to larger hospitals which offer specialised treatments and admit inpatients for overnight stays.

The term managed care or managed healthcare is used in the United States to describe a group of activities ostensibly intended to reduce the cost of providing for profit health care and providing health insurance while improving the quality of that care. It has become the essentially exclusive system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.

...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.

Family medicine (FM), formerly family practice (FP), is a medical specialty devoted to comprehensive health care for people of all ages; the specialist is named a family physician or family doctor. In Europe the discipline is often referred to as general practice and a practitioner as a general practice doctor or GP; this name emphasises the holistic nature of this speciality, as well as its roots in the family. Family practice is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body; family physicians are often primary care physicians. It is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is to provide personal, comprehensive, and continuing care for the individual in the context of the family and the community. The issues of values underlying this practice are usually known as primary care ethics.

Health care prices in the United States describes market and non-market factors that determine pricing, along with possible causes as to why prices are higher than other countries. Compared to other OECD countries, U.S. healthcare costs are one-third higher or more relative to the size of the economy (GDP). According to the CDC, during 2015 health expenditures per-person were nearly $10,000 on average, with total expenditures of $3.2 trillion or 17.8% GDP. Proximate reasons for the differences with other countries include: higher prices for the same services and greater use of healthcare. Higher administrative costs, higher per-capita income, and less government intervention to drive down prices are deeper causes. While the annual inflation rate in healthcare costs has declined in recent decades; it still remains above the rate of economic growth, resulting in a steady increase in healthcare expenditures relative to GDP from 6% in 1970 to nearly 18% in 2015.

Mid-level practitioners, also called assistant practice clinicians, are health care providers who have received different training and have a more restricted scope of practice than physicians and other health professionals in some states, but who do have a formal certificate and accreditation through the licensing bodies in their jurisdictions. Advanced Practice Provider (APP) is a term which Nurse Practitioners, Nurse Anesthetists, Physician Assistants, Clinical Nurse Specialists, and Nurse Midwives prefer for themselves rather than "Mid-level provider". The terms "Mid-level provider" or "Mid-level practitioners" have been widely accepted for many years however, they are now seen as derogatory and offensive. Many providers simply prefer their professional title, such as nurse practitioner (NP) or physician assistant (PA).

Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance "is used to describe any form of insurance providing protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.

Healthcare in Israel

Healthcare in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli residents are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations, known as Kupat Holim which are run as not-for-profit organizations and are prohibited by law from denying any Israeli resident membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance. In a survey of 48 countries in 2013, Israel's health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51. In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings and ranked eighth in terms of life expectancy.

Healthcare in Finland consists of a highly decentralized three-level publicly-funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, the municipalities are responsible for providing healthcare to their residents.

In the United States, direct primary care (DPC) is a type of primary care billing and payment arrangement made between patients and providers, without sending claims to insurance providers. It is an umbrella term, incorporating various health care delivery systems that involve direct financial relationships between patients and health care providers.

Health care in Slovenia is organised primarily through the Health Insurance Institute of Slovenia.

Healthcare in Belgium

Healthcare in Belgium is composed of three parts. Firstly there is a primarily publicly-funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.

An Accountable Care Organization (ACO) is a healthcare organization that ties payments to quality metrics and the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of its services. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".

Healthcare in Liechtenstein

The nation of Liechtenstein has a universal health care system with decentralized, free market elements through mandated health insurance coverage for every person residing in the country.

An adult-gerontology nurse practitioner (AGNP) is a nurse practitioner that specializes in continuing and comprehensive healthcare for adults across the lifespan from adolescence to old age.

References

  1. ↑ "Heavenly Blessings appeals closure order". Royal Gazette. 8 November 2018. Retrieved 15 November 2018.
  2. ↑ "Contact Us". Bermuda Hospitals Board. Retrieved 4 December 2012.
  3. ↑ "Hospital reveals harm figures". Royal Gazette. 10 July 2018. Retrieved 15 November 2018.
  4. 1 2 Keith Archibald Forbes. "Bermuda Healthcare costs". bermuda-online.org/healthcare. Retrieved 2 September 2018.
  5. ↑ "Licensed and Approved Health Insurers" (PDF). Archived from the original (PDF) on 4 August 2016. Retrieved 2 January 2017.
  6. ↑ "Call for paramedics to save lives on island". Royal Gazette. 22 October 2018. Retrieved 15 November 2018.
  7. ↑ "Nurse can write prescriptions". Royal Gazette. 25 September 2018. Retrieved 15 November 2018.
  8. ↑ "Atherden stands her ground on medical scans". Royal Gazette. 19 October 2018. Retrieved 15 November 2018.
  9. ↑ "There on the horizon – ICD-10CMs" (PDF). Newsletter. Vol. 7 no. 1. Bermuda Health Council. April 2016. Archived from the original (PDF) on 2 January 2017. Retrieved 2 January 2017.
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