are brought under control and all Islanders are given access to good care.

Yesterday Government released the long awaited Health Care Review which has been almost three years in the making.

It contains 24 pages of recommendations -- although it concludes that Bermuda's health care system is generally good, but fragmented.

The report's main theme is the creation of a new Bermuda Health Council acting as an umbrella group overseeing all aspects of health care.

It also suggests introducing a new health plan and urges authorities to try new methods of care, such as home care for the elderly, to halt rising costs.

In addition it calls for better health education to ensure prevention of illnesses and questions the need for so much overseas treatment when the services are available in Bermuda.

The report also calls on Government to introduce or update a raft of laws ranging from mental health to the Protection of Children Act.

Last night Health Care Review Committee chairman, Sen. Alf Oughton said it could take a couple of years to set up the Bermuda Health Council, but other interim measures could be introduced immediately.

He added: "The health care system is in pretty good shape but it is so fragmented. There are all these groups working but there is no umbrella organisation.

"The Bermuda Health Council is the major recommendation of the report, all the others follow on from that.

"What the report is trying to do is put up signposts for what should be worked towards over the next five or ten years.

"We were surprised by how much we found, but the exercise has not been done before.'' Sen. Oughton said there were some "political hot potatoes'' in the report including axing Government's under-16-year-old subsidy, saving $4 million.

That could be used to increase the subsidy for the elderly and save poor elderly people from slipping through the health net.

He met last week with Cabinet to introduce the report and said it had been well received.

"What we tried to tell them was that we did not expect the recommendations to go into place next week. We see this as a transition to take place over the next five to ten years.'' But he added: "This report will not gather dust if I am around. I was concerned that Cabinet was going to shelve the report until November when the House reconvenes.

"I am going to see that there will be action and I am certain that both the Ministers of Health and Finance see the need.'' The Committee was set up amidst a background of rising health costs for Government and insurance companies and poor public perceptions of the standard of services on the Island.

It was charged with finding ways to ensure the system was cost effective, efficient and gave a minimum level of care for all residents.

On the cost side, the committee said this year nine percent of Bermuda's $1.9 billion Gross Domestic Product -- the total amount the country earns and spends -- will go on health care, a rise of one percent from 1993.

Over the last decade the cost of health care has increased by more than 100 percent yet inflation has risen by 65 percent. The report says the rise will continue unless new ideas are introduced.

And in 1993 the average household spent $2,700 a year on health care -- more than double the 1982 figure with health insurance accounting for 63 percent of the cost.

It is expected that as people live longer the cost of health care will increase. Eleven percent of the population are aged over 65 and that is expected to rise to 14 percent within five years.

Report: `There's a limit to the financial burden that families and govts. can bear' Expectations will also rise as people want better care and expect state-of-the-art equipment.

The report says: "Medical expenses will continue to absorb an increasing share of household expenditure. However there is a limit to the financial burden that families and governments can bear.

"It is essential, therefore, that guiding principles and policies be established to manage the health care system and control health care costs.'' To help keep things in check the review recommends establishing a Bermuda Health Council (BHC) with a wide ranging brief.

It would control a fragmented system, ensure health care services are available to all Islanders at a reasonable cost and high quality and promote policies for a healthy community.

There could also be a new Basic Medical Package -- with the BHC being responsible for constantly reviewing the scheme -- to ensure health services are available to everyone at a reasonable cost.

In 1993 ten percent of the population had no health insurance cover and 74 percent only had major medical coverage. The rest had minimal cover.

"Without a basic medical package there is no ceiling to the amount of medical care which patients might want or to the costs which could be incurred by Government,'' says the report.

Major cost findings included King Edward Hospital spending about $5 million a year -- mainly subsidised by Government -- on caring for people such as the elderly who could be housed in a nursing home.

It also suggests that with one major supplier on the Island drug prices are fixed and should be controlled.

Costs of physicians' services also rose by 42 percent between 1990 and 1993 as more services were carried out in a doctor's surgery, some services were over utilised and more advice was sought from specialists instead of a family doctor.

There were also a number of common perceptions which led to increased costs including insurance companies "ripping off'' clients although there was no evidence to support this.

"Another area of concern is the perceived lack of confidence in the health care system which has in turn led to increasing requests for treatment overseas, with accompanying increased costs, even though adequate services are available locally,'' said the report.

"Bermuda is a small community and one small hiccup in the system is very quickly magnified and passed throughout the country.

"The consumer in Bermuda needs and wants to believe in the local health care system and the system needs the support and faith of the consumer if it wants to grow successfully.'' It is expected the report will go before the House of Assembly in November for debate, although no time-scale is being put on any new or up-dated legislation.

Last night Finance Minister Grant Gibbons said there would now be a series of meetings of a small Cabinet committee, chaired by Health Minister Harry Soares, to study the report in-depth.

"What the report is saying is that the health system is in pretty good shape, but it is making a series of recommendations to make sure health care remains in good shape in Bermuda,'' said Dr. Gibbons.

Mr. Soares said: "The warning is that there are changes coming and we have to plan for those changes. What we have to do is look at the report and study in detail.

"There will have to be a lot of consultation but the idea is to make some commonsense changes over the next few years.'' Major recommendations from health report -- Page 3