An online survey of 78 expatriates was used in the Johns Hopkins report to understand the Island's trends in overseas treatment.

The 63-page report, which reviewed a 2006 Cannon Design document on hospital services, was released by the Health Minister Nelson Bascome in the House of Assembly on Friday.

It identified three key factors — nonacute care, the insurance reimbursement system, and the length of patients' stay — as significant in influencing the size and cost of a new hospital.

The King Edward VII Memorial Hospital is set to expire its natural life by 2012 as will the Mid Atlantic Wellness Institute.

Before a new hospital is built, however, Government has said these reviews must be completed.

The document released on Friday was phase one of a two-phase project and underlining its analysis of off-Island healthcare treatment was a 26-question survey taken by expatriates.

Justifying the small sample and the people sampled, the report states that: "Based on the sample size of 78 and random selection of survey takers, the results can be extrapolated to the entire community on Bermuda.

"Further using the results of this expatriate survey in determining the probability and extent of patient conversion among Bermudians is an acceptable and conservative approach, as the expatriate perception of local healthcare in general is more conservative then the average Bermudian sentiment."

Questions asked in the survey included: For which of the following health care needs do you or would you and your family go off island?

And, If you would choose to not have your care delivered at KEMH please check all the following that contribute to your decision.

Elective surgery had the highest number of respondents with 76.7 percent saying they would receive it overseas, followed by 68.5 percent going abroad for cancer treatments.

Giving reasons for seeking these treatments overseas, 78.2 percent of the responders replied that the quality of the hospital facilities was the main reason they would seek services abroad.

Right behind that response was 54.6 percent saying the quality of care provided by physicians or other professional providers was the reason they would go abroad.

Basing their conclusions about healthcare received abroad on these responses, the report concluded that a new facility managed by an American academic medical centre would keep more people on the Island.

The report stated that: "Finally, if the KEMH were managed by a reputable US organisation, the rate would go up to 60 to 70 percent, which indicates that the majority of the patients would stay on the Island for care."

Justifying the sampling, it said: "For qualitative, analytical purposes, the potential conversion rates in the various scenarios were extrapolated on the foreign insurance claim analysis numbers that were, in turn, compared to KEMH levels."