title: Toward health reform for seniors in Bermuda: historical constraints on political possibilities.
abstract: In 2009, as the United States moved toward health care reform, the government of Bermuda implemented its FutureCare program to make health care for seniors more affordable. This article investigates how preferences for reform and its eventual design were shaped by the country's social history and commitment to free market values. Data derive from 36 in-depth interviews with key stakeholders deemed knowledgeable about health care financing and delivery in Bermuda, including government officials, provider representatives, insurance executives, and consumer advocates. Data also derive from a variety of documentary sources. Results indicate that although a clear need for health care and the ability to finance it for seniors exists in Bermuda, the scope of reform was circumscribed by preferences for prior policy decisions, creating a favorable tax and business environment for international corporations and a minimalist social welfare state for addressing racial and economic inequality. This suggests that widespread agreement on the challenges in meeting the health and long-term care needs of the elderly does not necessarily lead to equally commensurable solutions to addressing it.
authors.affiliation: Department of Gerontology, Gerontology Institute, University of Massachusetts Boston, Boston, Massachusetts 02125, USA. edward.miller@umb.edu
authors.forename: Edward Alan
authors.initials: EA
authors.lastname: Miller
authors.forename: Pamela
authors.initials: P
authors.lastname: Nadash
mesh_terms: D000368:Aged; D001605:Bermuda; D003159:Community-Institutional Relations; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006270:Health Facility Administrators / Q000191:economics / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration*; D008297:Male; D009313:National Health Programs / Q000458:organization & administration; D036301:Qualitative Research; D012946:Social Welfare; D012959:Socioeconomic Factors