Health insurers could find themselves being regulated by a Government commission following claims that payments for different procedures are changed "at their whim''.

Dr. Burton Butterfield told The Royal Gazette that a Government task force on health care will be discussing the implementation of a special commission to oversee insurers.

He said the commission was necessary to prevent insurers from "changing their rules and procedures at their whim''.

"I have seen insurance companies agree to pay a certain amount for a procedure,'' Dr. Butterfield said, "and then later change their minds and drastically cut back on the figure''.

"They do whatever they want, and nobody is able to stop them.'' Dr. Butterfield also said that insurers wield too much power in setting fee schedules for medical practioners and in determining reimbursement for services at King Edward VII Memorial Hospital.

And he further suggested that they are largely responsible for the poor financial situation of the hospital.

"The reimbursement system used here is very archaic,'' he said. "It is because we only have the one hospital that it has been kept going, anywhere else it would have been closed.

"You cannot afford to operate a facility that just loses money,'' he added.

In Bermuda there is a straight, per diem rate charged at the hospital for in-patients, irrespective of the treatment they are receiving. This means a patient who spends the night in the intensive care unit, is charged the same as a patient who is recovering from knee surgery in a general ward.

Dr. Butterfield said most physicians in Bermuda agree that patients should be charged only for the procedures they have undergone and treatment they have received.

"In the United States you are charged for each individual thing but here they have the per diem figure,'' he said.

The matter was also raised last year by the Arthur Andersen consulting firm which was brought in to investigate Bermuda's health care system. At a special presentation consultant Dr. Charles Peck had illustrated how the current system hurts the Hospital's bottom line.

Upset that local insurance companies often try to lay the blame of rising health care costs on physicians and the cost of technology, Dr. Butterfield called on the insurers to investigate their own operations.

See related story, Page 11 Health insurers charging `at their whim' He pointed to and agreed with a recent Letter to the Editor of The Royal Gazette by Dr. Terence Elliott, who said physicians' fees in Bermuda are on average 30 to 50 percent less than their counterparts in the US.

"They are big rich companies, they have a lot of profit, they need to look within themselves,'' he said. "They need to accept that a major reason health care costs are increasing is because their premiums are going up.'' Heads of the largest health insurers reserved comment when contacted yesterday.