Spending on overseas healthcare has more than doubled since 2004, topping $84.5 million for the 2015-16 fiscal year, the Bermuda Health Council reported.

At nearly $40 million, almost half the spending went to Massachusetts, primarily in the Boston metropolitan region. Maryland came second.

Most trips were for specialised care unavailable in Bermuda, such as the 32 patients seeking treatment for “complex, brain related injuries”, the report said — often as a result of traffic accidents.

Local patients travelled to more than 5,000 services overseas, with claims averaging $345 more than to local providers,

Overall, services spanned 41 states and 29 countries, with 28 of the locations seeing revenue of more than $100,000 from Bermuda residents.

The report’s publication was occasion for local providers, and specialists in particular, to “take the lead” in referring residents to cost-effective facilities, according to Tawanna Wedderburn, CEO of the Bermuda Health Council.

The synopsis concluded that it could serve the island to examine becoming a “centre of excellence” for the Caribbean region, which has some 40 million residents.

With the East Coast of the United States close by, a potential 112 million people lie within reach of the island.

“There may be opportunities for Bermuda to become an overseas preferred location for strategic quality health services,” the report continued.

“This has the added benefit of enhancing care quality and access for local residents to be cared for on island.”

Overseas spending peaked at $101 million in 2013, meaning the latest figures represented a significant decrease — but the island still spends a larger portion abroad than similar small jurisdictions.

Outside of hospital care, the most common services used overseas were paediatric care, spinal care, dermatology, radiology, pharmacy, pathology, psychology, ophthalmology and orthopaedic medicine.

Ricky Brathwaite, the BHeC’s director of health economics, said residents should “ask more questions about costs and quality”, and “insist that health professionals, policymakers and insurers make the best decisions about treating and paying for our physical, mental and dental health”.