MEMORANDUMDATE: 21st September 2018

TO: Health Financing Reform Stakeholder Group Representatives

FROM: Ricky C. Brathwaite, Director Health Economics, Bermuda Health Council

RE: Consultation Components for Health Financing Reform Stakeholder Group

Thank you for agreeing to participate in the Health Financing Reform Stakeholder Group. This group has been created to look at how the structure of financing could be refined for Bermuda’s health system as we work towards improving the health of our residents, ensuring cost effective healthcare options and achieving a more fair and efficient healthcare environment. There has been work done previously to identify feasible financing models (termed “Dual” or “Unified” model) and we ask that you review those models and their potential implications in respect of the larger goals of the health system.

Over the next 3-4 weeks, we are asking each participant to meet with their respective stakeholder groups to review the consultation questions and their related documentation. Meeting with your members can be in any format that you believe best captures their input on the included questions (e.g., large forum, electronic survey, emailed responses). The goal of the process is to then obtain a summary of your stakeholder group’s robust perspective about the financing structures (8 questions) that can enhance the delivery of care in Bermuda and funding available for our health system.

As you review the documents, we will set up meetings that will allow you to ask clarifying questions or better understand project objectives. These meetings, whether in person or via conference call, will be sent out for all participants as needed, based on your request. A summary of your representative memberships’ answers to the questions (e.g., seniors, mental health practitioners, patients) should be submitted electronically by 12th of October to Dr. Ricky Brathwaite (rcbrathwaite@bhec.bm).

Submissions should be separated according to each question. Concise answers would be helpful as all stakeholder group feedback will ultimately be aggregated into a single document for sharing.

Thank you again for participating and if you have any questions or concerns, please feel free to contact me via email or at 292-6420.

Thanks again,

Dr. Ricky C. Brathwaite, PhD, MS, MSHSDirector, Health Economics (Health Financing Reform Steering Committee)Bermuda Health Council

Participants:

Mr. Anthony Santucci (Patient Representative) Ms. Betsy Baillie (Bermuda Diabetes Association) Dr. Amanda Marshall (Mental Health) Dr. Annabel Fountain (BMDA)) Dr. Michael Richmond (Hospital) Dr. Reid Robinson (or Dr. Laura Dowling) (Provider) Ms. Ianthia Wade (Seniors) Mr. Jason Hayward (BPSU) Mr. Jonathan Peacock (Colonial) Ms. Kathy Swan (Nursing) Ms. Kendaree Burgess (Chamber of Commerce) Ms. Kirsten Beasley (International Business) Ms. Michelle Jackson (BF&M and Bermuda First) Peter Lozier (Argus)

Questions to Participants (Feedback due 12th October)

Primary Questions (See Related Primary Documents):

1. Does the Report on a Health Financing Structure (See Primary Background Documents) capture the health system concerns related to your members, and if not, what financing concerns is it missing?

2. Which financial structure (Dual or Unified) indicated in the report makes our healthcare system stronger? And why?

3. What level of involvement should the government, associated organizations (e.g., QUANGOs), or the private sector have in the management of a Dual or Unified financial structure?

4. What are some key attributes that a new financial structure should accommodate when it comes to enhancing patient care and outcomes? (e.g., case management, efficiency in administration, good customer service, governance)

Primary Background Documents (links and embedded documents – click below to view):

Report on a Health Financing Structure in Support of Bermuda’s National Health Plan and Bermuda Health Strategy

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Bermuda Health and System Reform Overview

Bermuda Health Strategy Bermuda Health Strategy

Additional Questions (See Related Supporting Documents):

5. What risks and/or benefits would guaranteed access create for your stakeholder group? Guaranteed access means that all residents would be able to purchase at least the minimum insurance with no conditions attached to it.

6. What is your view on mandating health insurance coverage, regardless of employment status?

7. For health insurance, what should be the conditions of patient subsidy for SHB coverage? Who should be priority groups that are subsidized partially or fully? Current subsidization is based primarily on age and to a lesser degree on income.

8. Any other concerns?

Supporting Documents (links and embedded documents – click below to view):

Single Payer Review Papers Single Payer Health System and Quality

Risk Pooling Review Papers Cross State Risk Pooling Risk Pooling - Actuaries

Implementing Health Financing Reform Review Papers WHO Health Financing Reform Health System Efficiency

Guarantee Access Individual Market Guarantees

Mandatory Health Insurance Universal Mandatory Health Insurance Universal Access in a Voluntary Market

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