In December, the then Bermuda Health Minister Patricia Gordon-Pamplin announced the OBA was looking to introduce pre-certification to the medical industry.
This means that our physicians will be required to get approval from a faceless person on the end of a 1-800 number before any medical diagnostic procedures can be performed.
The Why?
“I hear that certain doctors are being incentivized when diagnostic testing is done.” Minister Gordon-Pamplin – RG December 2, 2013. If there is proof of abuse by specific doctors then efforts should made to tighten controls and enforcement thereof.
Minister Gordon-Pamplin justified pre-certification as OBA’s attempt to contain health care costs. Last year, $50 million was spent on diagnostic testing, which equates to approximately 8% of healthcare expenditure. This is in comparison to hospital costs which amount to 44%. OBA projects that pre-certification will result in a saving of $6 million, representing a mere 1% of the $679 million in total costs.
However, OBA failed to factor in the costs of implementing this initiative. Costs include employing staff to manage the pre-certification process, which will probably be passed on to the patient.
What is the real motivation to focus on such a small driver of health care costs? Is it linked to the recent Throne Speech announcement that OBA will implement controls on the importation of medical equipment by private health providers?
While OBA stated that this was to curtail health costs, they failed to reveal:
• some private medical facilities charge MRIs at 80% of the cost of the hospital
• the KEMH CT scan has occasionally been inoperable and patients were dependent on privately owned CT.
Recently, the diagnostic imaging fee schedule was released, with cuts of more than 50% for certain scans. If this is allowed, the island’s only CT option outside KEMH will be shut down. The fee schedule has subsequently been abruptly withdrawn.
Health Risk
Pre-certification does not have the support of the Bermuda Medical Doctors’ Association [BMDA] who represents the Island’s physicians. BMDA views pre-certification as a safety risk to patients because:
• patients are forced to wait for permission to have necessary diagnostic testing i.e. “death by delay”
• it directly interferes with patient care
• who will be liable if a patient dies or health status worsens as a result of a refusal to grant permission for diagnostic testing?
OBA Collaboration?
“I don’t make decisions or look at information in isolation……I consult with people who are in the field.” Minister Gordon-Pamplin – RG December 2nd, 2013
“This decision was taken in the complete absence of consultation with physicians, and as such puts the safety and care of our patients at risk.” Dr Sherratt-Wyer – RG January 14th, 2014
A Bermuda Health Council [BHeC] spokesperson confirmed that they were instructed last year by Cabinet to implement pre-certification. RG January 14th, 2014.
The BHeC oversees local healthcare and has been given the mandate by government to develop pre-certification procedures. Local doctors have expressed concerns that the BHeC lacks physician input and that it has evolved to be a body that tends to make “pencil and paper” decisions without understanding the human impact of their decisions.
Seems fairly obvious the medical fraternity was not consulted beforehand.
The questions that Bermudians have to now ask themselves are as follows:
A. Do you trust your doctor with your health?
B. Do you trust the OBA with your health?
C. Death by delay?
(N.B. The Opinions expressed herein are not those of the Caribbean Medical News. This is an opinion piece by the author)
