Island nations all face similar unique challenges in the delivery of healthcare, ranging from lower economies of scale, due to a limited pool of patients, to the need for overseas care for certain treatments.
To address escalating healthcare costs, countries need to ensure their health systems are fully opimised and take advantage of new technologies that change the way healthcare is delivered, says Dr. Edward Fitzgerald, the regional head of KPMG’s healthcare advisory practice for Bermuda and the Caribbean.
“I would say there isn’t an island that isn’t facing some challenges around healthcare costs. This is inherent in the nature of the provision of island healthcare,” Fitzgerald said in an interview with the Cayman Compass. “The pool of people who need to be serviced poses challenges, particularly when a degree of that healthcare is always going to end up being off island.”
Cayman, at least, is in a favourable position because its population is comparatively young, while other islands are grappling with demographic change and ageing societies.
“Demography is a global problem and there are many islands in the region that would be envious of Cayman’s current demography because they are very skewed towards older populations,” he said.
The big advantage for Cayman is that it does buy some time to prepare for demographic change or longer-term chronic healthcare challenges.
Most island nations are aware that there are opportunities for optimisation, Fitzgerald said, with some obvious areas around staffing and overtime, supply chains, the sourcing of pharmaceuticals and other technical matters. But the real win comes from reconfiguring the care model itself and redesigning how care is delivered.
“There are particular opportunities for islands around digital health. Because I think one of the one of the big issues for islands is what can be delivered onshore, what has to be delivered offshore, and how are the costs covered?… [H]ow is the condition managed, if the patient isn’t able to travel?”
Digital health is not a panacea for all the ills, Fitzgerald said, but it still represents a quantum leap for face-to-face consultations, monitoring or at-home testing.
There is a huge range of patient services that are currently delivered in more expensive secondary care facilities that in the future can be delivered directly to the patient on island or at home.
One example for this in the UK is a pilot project in response to a huge backlog in endoscopies, which are an important diagnostic tool in cancer care, for example.
“They are going to start posting video capsules that you swallow. You can just have an endoscopy at home. The information will be downloaded and then sent to the hospital. That is a huge paradigm shift in the future delivery of care, which is very exciting,” Fitzgerald said.
“Healthcare is the last major market sector that hasn’t been through digital transformation and the opportunity to improve care in a more timely fashion and take substantial costs out of the system, because you’re not putting someone on a plane to John Hopkins anymore, is going to be immense.”
Such alternatives to sending patients to the US reap rewards for health systems across the region.
Cayman’s challenges in providing universal healthcare and addressing cost issues around indigents, or uninsured people, are also shared by its neighbours.
The Bahamas introduced a government-based, national health insurance for primary care. Bermuda is contemplating taking the first step toward universal healthcare coverage.
“These challenges can seem very new, and the solutions that are proposed can seem very radical. But, actually, if you look globally, the majority of the world has now already tackled this issue.”
The different models range from entirely government-provided systems with government-owned or contracted facilities to insurance-based models with split levels of care that provide standard health benefits at a basic level and additional benefits on top paid for by the insured or the employer.
But Fitzgerald believes there is not one right answer or one ideal model. “I think what needs to work is a Cayman-centric model. And that will probably learn lessons from all of those in order to find what works best locally.”