The Island’s doctors’ trade union has come out against proposals they get prior approval for some diagnostic testing.

The Bermuda Medical Doctors Association (BMDA) said it saw “with some dismay” a Ministry of Health request for proposal for a firm to set a precertification for tests in a bid to drive down spiralling healthcare costs.

“The BMDA is committed to improving the quality of healthcare provision to the whole population of Bermuda,” a spokesman for the BMDA said.

“We remain opposed to the implementation of precertification.

“We are, however, committed to making healthcare costs sustainable.”

The Government said precertification for some testing — like lab tests and orders with a total cost of $300 or more — was needed to cut costs.

But the BMDA said — while it was against precertification — it had produced its own report in July, which included 20 recommendations designed to lower the cost of healthcare.

The report has yet to be made public, but the BMDA said it dealt with some of the causes of the biggest increases in health costs — the Bermuda Hospitals Board and overseas treatment.

The spokesman added: “However, the BMDA felt it was vital that we took a holistic look the healthcare system in its entirety and as such the report specifically aims to address issues across the entire spectrum of healthcare, including community-based care.”

The spokesman added: “Indeed, this report was so well-received by the Bermuda Health Council (BHEC) that the BMDA and BHEC are already working on implementing some of the measures.”

The BMDA added that the Ministry of Health had taken part in a conference last year, where experts from the Caribbean and US, where precertification is already in place, told Bermuda it should not go ahead with its implementation.

The experts said that precertification did not change the behaviour of doctors — but that they tailored their reasons on forms so the precertifying body had to approve the investigation.

They also said the precertification could also delay access to treatment — even when, like the Bermuda proposals, emergency tests are not included in the precertification regime.

The BMDA said: “This may be true if a patient presents to the ER, but there are situations outside of the emergency room which require fast responses by the physician and waiting for precertification is not appropriate.

“Indeed, this may even drive up costs as primary care physicians (GPs) will be forced to send patients to the ER just to get the required testing done.”

And doctors warned: “There are cases where even a 24 hour delay could be extremely detrimental to the health of the patient.”

The BMDA added that patients would have to shoulder the cost of hiring a precertification company — which would increase costs due to extra bureaucracy across the healthcare system.

And the conference was told: “The biggest single driver to changing behaviour in the Cayman Islands was the implementation of guidelines, not the introduction of precertification.

“Supporting physicians with guidelines that aid them in providing the best level of care for their patients is much more effective at reducing costs than adding another level of bureaucracy and cost that is precertification.”

Precertification was earlier slammed by shadow Health Minister Kim Wilson as “unnecessary and dangerous.”

She spoke out after Health Minister Jeanne Atherden said that the move would lead to improve standardisation in the ordering of diagnostic tests and reduce the unnecessary use of and duplication in both medical imaging and clinical laboratory tests.

Ms Wilson said that diagnostic imaging amounted to less than two per cent of Island healthcare costs and said that changes in other areas could ease the financial burden without risking patient health — including allowing larger international insurance firms into the Bermuda market to increase competition and lower costs.