FEE SCHEDULES
In all health systems around the world, payments to healthcare providers like hospitals, labs and clinics make up the biggest share of costs. For this reason, the fees paid to providers is a critical concern for health system policy-makers whose job it is to ensure sustainability over the long run. Presently health system policy-makers everywhere are grappling with maintaining and improving efficiency, access, and quality, while containing costs.
In Bermuda provider fees are regulated for the Standard Hospital Benefit (SHB) and for in-hospital treatment by physicians and dentists. There are three schedules regulating these fees:
Bermuda Hospitals Board (Hospitals Fees) Regulations
Bermuda Hospitals Board (Medical and Dental Charges) Order
Diagnostic Imaging Fee Schedule
The fees are set by government and are reviewed annually to ensure healthcare providers are fairly compensated, while seeking to contain the growth in healthcare costs. The economic conditions of the current year and the following year are taken into consideration to ensure there is no undue financial pressure on the health system.
Hospital Fees
The Bermuda Hospitals Board (Hospital Fees) Regulations consist of four schedules for Inpatient and Outpatient fees for King Edward VII Memorial Hospital and the Mid-Atlantic Wellness Institute.
Schedule 1 – Inpatient Treatment by Diagnosis Related Group (DRG)
Schedule 2 – Inpatient Treatment per Diems and Room Differentials
Schedule 3 – Bermuda Hospitals Board Physician Services
Schedule 4 – Outpatient Treatment
Medical and Dental Charges
Fees for hospital-based treatment by private physicians and dentists are regulated and set by the Bermuda Hospitals Board (Medical and Dental Charges) Order (the Order). The Order sets physician and dentist’s fees for the treatment of patients in Bermuda Hospitals Board (BHB) facilities, and for any follow-up treatment in relation to a BHB facility-based treatment. BHB facilities are King Edward Memorial Hospital, Mid-Atlantic Wellness Institute, and the Lambe-Foggo Urgent Care Center.
The Medical and Dental Charges Order is a schedule to the Bermuda Hospitals Board Act 1970. Under section 13A of the Act physicians and dentists are prohibited from charging fees beyond those set by the Order for services performed within BHB facilities. Fees for services in private healthcare practices are not regulated. Health professionals can set their own fee levels for non-hospital services performed in their private offices.
Diagnostic Imaging Fee Schedule
Many outpatient diagnostic imaging services are covered under the SHB at the hospital. Some of these services are also provided by private facilities outside the hospital, approved by the BHeC. The Diagnostic Imaging Fee Schedule lists the approved procedures and corresponding reimbursement rates.