The cost of health care in Bermuda has increased 100 percent over the past decade due to greater technology, an aging population and more demanding patients, it was claimed yesterday.

The Health Insurance Association of Bermuda (HIAB) spoke out following a number of concerns raised recently over the rising cost of health facilities on the Island.

President Gerald Simons said while the price of health care has more than doubled in the last ten years, the cost of living has only increased 65 percent.

And he said as a result, employers were seeing dramatic increases in costs to their business and were looking for relief and partnership opportunities with the medical community to improve quality and lower costs.

To show the growth in costs, Mr. Simons said between 1990 and 1997, the Island saw almost a four percent increase in health expenditures, from 7.3 percent of the gross national product, to 11 percent.

However, in comparison, the US only increased 1.3 percent in that period, the UK rose by 0.6 percent, and Canada actually managed to decrease its health spending by 0.3 percent.

And Mr. Simons said between 1997 to 1998 alone, Bermuda increased its spending on the health system by $8 million.

Of that $8 million, $2.3 million was borne by the Government, $4.3 million by insurers and $1.4 million by consumers.

The president said: "What is driving the rapid increase in health care costs? An aging population, increases in technology, rising cost of pharmaceuticals, consumer expectation and increased demand, and the supply of providers and the increased utilisation.

"Today, we effectively have universal health insurance coverage with the overwhelming majority of the working population having access to high quality care in Bermuda and in North America.

"Today, while few people question the quality of care, there is growing concern over the rising cost of health care in Bermuda.

"Mr. Hume Martin, in one of his annual reports as chief executive officer of the Bermuda Hospitals Board, noted that health care costs were rising at such a rate that if these costs were not checked, Bermuda would not be able to afford other social services, such as schools and roads.

"The HIAB is also concerned that escalating health care costs, which directly affect premiums, may force employers and individuals to reduce or eliminate health insurance coverage.

"There is also growing concern about the need of the elderly and the retired population to have adequate health insurance."

But Patricia Burke, vice president of Argus Insurance Group, said the consumer played a large part in the rising costs.

She said the customer had a choice of where he or she wanted to be treated, and sometimes opted to go to North America, instead of staying in Bermuda, which is cheaper.

She said there were times when it was advised that they go overseas for specific medical attention.

However, often it was simply because the patient felt they would get better care and better treatment.

Mrs. Burke said: "In a lot of cases, the individual is choosing to go overseas.

"The numbers of people going overseas is going up.

"Yes, definitely, the consumer is pushing up the price."

And asked why people were not encouraged to stay more on the Island, Mr. Simons added: "People who use the hospital (King Edward VII Memorial Hospital), generally, are very pleased.

"My family have used the hospital, even the case of my sons from the day they were born.

"But people have choices.

"It's no different from `why do people like to shop overseas'?

And Mr. Simons said adding to the cost of health care in Bermuda was the cost of the drugs.

He said since 1996, the cost of drug expenditures had increased by 20 percent on average, annually.

He added: "Based on these trends, insurer expenditures on pharmaceuticals alone will double in five years, reaching approximately $12 million Island-wide."

However, two weeks ago, in The Royal Gazette Health Minister Nelson Bascome encouraged patients to ask doctors to prescribe generic drugs, as opposed to the brand name types, as it was much cheaper.

And yesterday, the HAIB's medical consultant Dr. Clarence James said while some physicians offered patients the generic drug, others did not, despite the Ministry of Health changing prescription forms to include a box for doctors to tick for generic drugs.

He said: "Prescription procedures of physicians vary considerably.

"Some do, some don't.

"There is a prescription form to make it easier for doctors to prescribe generic drugs, but still some don't."

Following two major reviews of the health service, key players, including the ministry, are now working together to implement recommendations and make improvements.

President of the Senate Alf Oughton has called for checks on costs to be carried out, and for a Bermuda Health Council to be formed to act as a watchdog for the industry.

And yesterday, Mr. Simons said he also hoped a council would be set up.

He said an umbrella body was needed to ensure the service provided what the community wanted, as opposed to what the service wants to provide.

For example, he said the community should be deciding what new piece of equipment it wants, or whether more money should be spent on drug rehabilitation, diabetes.

And he said there should be more control to ensure the right kinds of specialists were allowed into the Island to work.

That would prevent having too many of one kind, and not enough of others.