Health Care Review report.

Patients stay in hospital longer in Bermuda than they do in the US -- and that helps to drive up health care costs, the House of Assembly was told on Friday.

Shadow Minister of Health and Social Services Renee Webb said: "One of the areas the task force looked at was length of stay in hospital. To make the hospital more cost efficient, you have to look at length of stay,'' she said.

"I'm surprised at some of the disparity between Bermuda and the US.'' She said that, for example, the length of stay in a Bermuda hospital for a leg fracture was 40 days, while in the US it was 14.2 days on average.

"This is a large disparity. If looking at cost, that is something that can be controlled.'' Ms Webb said doctors should justify why there is such a disparity.

She also said that the task force found a wide price range for prescription drugs. In one case, the difference was as high as 55 percent, she said.

On the report's recommendation to discontinue the youth subsidy, Ms Webb said that money could instead subsidise health care costs of individuals over 65.

"Most (in the youth group) are subsidised anyway by the insurance of their parents.'' She also said the report recommends that costing at the hospital take place and that it was a "concept long overdue.'' The report also pointed to a recommendation that the proposed BHC have the power to examine a doctor's fees and set fees.

It remains to be seen how the medical community would react to this, especially when other professions' fees are not regulated, she said.

"Maybe this is a place to start.'' She suggested that a BHC would never get off the ground without the support of the Island's medical community.

The report went on to suggest a BHC membership should be chaired by a non-partisan individual appointed by the Minister of Health.

Ms Webb said there was no such thing as non-partisan in Bermuda, but including two consumer advocates in the council would be a plus.

The report also promoted preventative medicine, Ms Webb said. But some health insurance companies refuse to pay for investigative procedures, she added.

Ms Webb said she did not necessarily support the report's recommendation that a BHC not have to report to any particular Ministry despite the fact that it would be paid for by the public.

Finance Minister Grant Gibbons said the report showed "we're not in great trouble now, but if we don't heed this signpost, we'll have trouble in future.

There are a number of signposts that we can do a better job of coordinating costs.'' Escalating costs, the ageing population and advances in technology were starting to exert pressure on the Island's health care system.

Ten percent of the Island's population is over 65 now. That percentage will reach 12 by the year 2011, 14 percent by 2021 and 17 percent by 2031.

"In Bermuda we spend 8.5 percent, or $155 million, of Gross Domestic Product on system health care costs. In 1995, the US was about the highest (in a list of eight developed countries) at 14 percent.'' Dr. Gibbons added that the report did not thoroughly look at the role of Government. He also cited accountability of a proposed health care council as a matter of concern.

Dr. Gibbons also said that in Bermuda there was a bias towards in-patient care and that the report's suggested alternatives, such as home care, should be pursued.

Physician Dr. Ewart Brown (PLP) said he did not see the Island's health care system in as good a light as Dr. Gibbons.

"My contact (with the system) is every day,'' he declared. "Dr. Gibbons' picture is understandably different. I can't say the system is well.'' Dr. Brown said there was "little incentive to get people out of hospital''.

And he added that insurance companies refuse to pay for certain types of counselling.

Government's health insurance plan cost more than private insurers' plans, but provided less coverage, he said. Dr. Brown said insurance companies had been allowed to "cherry pick'' the people it will insure causing the burden of the sick to be shifted to the Government.

"The elderly who require the health system the most, are the burden of the Government,'' he added. "This needs to be fixed.'' Dr. Brown said Bermuda was slowly developing a two tiered system, one where those with low incomes had Government insurance, the other with those who could afford private insurance.

He said that the idea of establishing the Bermuda Health Council made sense.

"The umbrella concept makes sense,'' he said. "It's in line with the rest of the world.

"The Bermuda Health Council could be a helpful force, if it will work for the people first and doctor's and insurance companies second.'' Dr. Brown said he anticipated the day when local doctors will be required to enrol in courses to update their skills.

"I hope one day that doctors have to take courses to stay licensed,'' he said. "In Bermuda you don't have to. Doctors have a lifetime licence.'' And regarding doctors' fees, Dr. Brown said: "Doctors are going to set their own fees. When the Government mandates that lawyers, architects and accountants get their fees set then they can, but until then, we will set our own fees.'' He also defended his colleagues against suggestions that doctors ordered tests that were not needed.

And he suggested a complete review on utilisation be conducted.

"I'm for a review, I'm not going to allow them to insinuate that I and others practise utilisation,'' Dr. Brown said. "Bring someone in to review things.'' He suggested Dr. Burton Butterfield was qualified to conduct such a review.

Noting that the Island had only one hospital, Dr. Brown recommended setting up some competition for the King Edward VII Memorial Hospital.

"We have a hospital that has no competition in a society that supposedly thrives on it,'' he said. "This hospital would be a better one if had a little competition.'' Dr. Brown suggested that if King Edward had competition from an establishment, "not as big'', many problems would disappear quickly.

On the issue of the elderly tying up beds at the hospital, Dr. Brown urged the Government not to build "concrete and glass'' to "warehouse'' seniors.

He recommended Government invest programmes that will allow the elderly to stay in their own homes.

Dr. Brown said "extending a hand'' and working with North American medical institutions would improve Bermudian's confidence in their health care system.

Technology and Information Minister John Barritt commended the report committee for producing the document.

Mr. Barritt said the report would be the benchmark by which measurements could be taken and said it gave an early warning of potential crises on the horizon.

MPs debate health He also said the report drew attention to the fact that the care and treatment of the elderly needed to be examined.

And he suggested that action be taken on issues that could be dealt with immediately.

"I would not like to see us hold off on areas we can tackle now,'' he said.

"We don't have to wait for the council to improve service at the hospital.'' Mr. Barritt also called for a balance between the need for profits and the health care of people.

Shadow Works and Engineering Minister Stanley Morton PLP echoed Mr. Barritt's praise of the report committee.

"It's an example to others and Government that you don't always have to send out for experts,'' he said.

But he expressed concern about persons unable to afford insurance.

Kim Young (UBP) said: "I hope we continue to review the health care system on a regular basis.'' She also said that though there are areas for improvement in the Island's health care system, the hospital is accredited regularly.

"Many seniors are anxious about health care. We need to find a way for seniors to take advantage of clinics so they don't end up in hospital,'' she said.

She supported the report's recommendation to increase health care subsidy for those over age 65 to 100 percent.

Ms Young expressed concern for individuals ages 60 to 65 made redundant.

"Often they find they can't get insurance coverage.'' She also said that employer medical insurance should apply to a spouse when the employee retires and that the Island needs more child psychiatrists.

Nelson Bascome (PLP) said that when dealing with take note motions, supplementary legislation is needed to make changes.

He also said that there needs to be certification for health care counsellors.

There is also a need for insurers to help with the costs of individuals whot have substance abuse problems.

And though health care often comes to those who can afford it, indigent people have just as much right to health care as anyone else in Bermuda, he said.

"One has to realise the level of services within a community of (only) 60,000 is exceptional,'' Youth and Sport Minister David Dyer said.

To expect some procedures and services in a jurisdiction of this size is unrealistic, he said.

Dr. Dyer, a dentist, also said there were instances where insurance companies have told individuals that there was a doctor in Bermuda who could do a certain procedure. It then turned out that doctor was the very doctor who suggested the patient have the procedure done overseas.

David Allen (PLP) suggested Government set up a commission to investigate why prices for medical items are so much higher here than in the US.

"Most object to paying extortionist rates,'' he said.

He laid the blame squarely on "a certain company'' which imports most of the Island's pharmaceuticals and operates several pharmacies here.

It is time for a "major inquiry,'' he said.

Mr. Allen also said Government should spend more money on parish rest homes.

He said one looked like a "Bosnian refugee camp.'' "The money is there'' to improve the parish rest homes, he said, concluding discussion on the report of the Health Care Review.