Healthcare costs are exorbitant in Bermuda — on that point, the public, medical professionals, and politicians of all persuasions are agreed.
They rank among the highest globally per capita and are rising, due to the rapidly ageing population.
There is a consensus that they are unsustainable and that, as the Progressive Labour Party stated in its 2025 election platform, the island is “in need of transformative healthcare reform”.
But building the ideal system is no simple task, as a look at health insurance around the world makes clear.
Every country grapples with how to manage costs, maximise access, ensure high-quality care and preserve consumer choice.
United States
Bermuda’s nearest neighbour has a system similar to our own – a mix of private insurance and public programmes, such as Medicare and Medicaid.
Those who have a job often have employer-sponsored insurance, while government schemes target specific groups such as seniors and those on low incomes.
The result is that some patients have a great deal of choice and can benefit from specialist and innovative care, as well as the latest technology. But there is unequal access and medical care doesn’t come cheap. Even those with insurance can find themselves facing huge medical bills.
United Kingdom
Britain’s National Health Service is both much-cherished and much-maligned. It is funded through general taxation and services are free at the point of use.
Universal access regardless of income or employment status is a plus, but in a country of more than 68 million people, the system is often described as “overwhelmed”.
Those in need of non-emergency care can face long wait times and there has been much discussion about the so-called “NHS postcode lottery”, which refers to inequities in access and quality depending on where a patient lives.
Bermudians relocating to England must register with a general practitioner practice to receive free primary care. They’ll be entitled to free NHS hospital treatment too, provided the move is permanent.
Canada
Canada’s healthcare system, known as Medicare, is publicly-funded and delivered through non-profit provincial and territorial insurance plans.
That means all Canadian residents can access medically necessary hospital and physician services without paying out-of-pocket.
However, there can be long wait times for elective procedures and the system suffers from a shortage of healthcare professionals.
Access for those in remote areas is a challenge. A 2023 study published in the Canadian Medical Association Journal found that about 20 percent of Canadians had no family doctor at all.
Other British Overseas Territories
Bermuda’s fellow British Overseas Territories are a mixed bag when it comes to health insurance.
Some, such as the British Virgin Islands and Turks and Caicos, have national health insurance plans which are still in their infancy.
The BVI scheme has been criticised for funding shortfalls, rising medical costs and delayed payments to healthcare providers, but its defenders say its goal of giving every resident access to affordable healthcare is a worthy one.
Residents of Cayman mostly have health insurance from private providers. Like Bermuda, the island has high-quality care but it is expensive and seen as unsustainable.
Britain has healthcare agreements with its overseas territories which mean some patients – including up to five a year from Bermuda – can access NHS services on the same basis as a UK resident.
Caribbean
A 2018 report by KPMG found that health systems across the Caribbean region were “preparing for an unprecedented period of reform, as governments set out their plans to achieve universal health coverage”.
The study said the region was well on the way to achieving UHC — citizens having access to the health services they need, when and where they need them, without financial hardship — by 2030.
Countries such as Jamaica and Barbados provide free or subsidised care, as well as private health insurance options.
Trinidad and Tobago also has a free public healthcare system available to all but wait times can be long and it can be difficult to find specialists.
Europe
Germany has social health insurance, which is funded by mandatory payroll contributions split between employer and employee. About 90 per cent of citizens have statutory health insurance and the remainder have private insurance.
In France, all citizens regardless of income or employment status, can access healthcare in a scheme which operates on a co-payment model. Patients usually pay upfront for services and receive partial reimbursement from the state-run public health insurance scheme.
Switzerland’s system is different again. Residents must buy basic insurance from private insurers but the prices and benefits are regulated by government and there are subsidies for those on low incomes. It’s widely seen as a well-run system, with excellent health outcomes.
Australia
Australia’s government proudly describes the country as having “one of the best” healthcare systems in the world, “providing safe and affordable healthcare for all Australians”.
That view was certainly shared by the authors of a 2024 report by the Commonwealth Fund, which ranked Australia number one in a study of health systems in ten countries.
The system is jointly run by all levels of Australian government – federal, state and territory, and local.
There is both a universal healthcare scheme, known as Medicare, which covers all of the cost of public hospital services and some other healthcare costs, and private health insurance.
Though it praised Australia, the Commonwealth Fund study found the country did “quite poorly” when it came to access to care.
Japan
The island nation has compulsory universal health insurance, with patients paying as much as a third of the costs for care out of their own pockets.
Quality of care is high in Japan, as are health outcomes, but there are funding and staffing challenges in hospitals.
As Bermuda works towards implementing its own universal healthcare system, guaranteeing access to necessary medical services for all, its leaders will continue to study the best elements of systems elsewhere.
The 2024 Commonwealth Fund study found that all countries have “strengths and weaknesses” and “all countries have something to learn from one another”.
