hundreds of thousands of dollars in costly cardiac health care, has materialised.

Healthy hearts will be easier to maintain for thousands of Bermudian residents following an agreement recently signed with Johns Hopkins University Hospital.

But yesterday Dr. Burton Butterfield, president of the breakaway Bermuda Medical Association, said the profession should have been consulted.

He added: "We don't object to people going to Johns Hopkins. It's a good institution, we just object to the way it was handled.

"As doctors we would be opposed if this is an exclusive contract -- that was not made clear and it should be.'' And he said: "We have a healthcare task force and we have these things happening outside the task force.'' Dr. Butterfield added: "Some patients may decide they want to go somewhere else -- and doctors should have some input into this.

"I imagine the insurers have got some kind of special rate, but that doesn't mean we couldn't get a special rate from other places.'' Residents insured with American Life, BF&M Life, British American, Crown Life, Somers Isles Insurance and the Government Employees Health Insurance Plan are now able to receive cardiac care at Johns Hopkins at a much reduced rate.

The three-year agreement was reached as the six insurance companies came together as the Health Insurance Association of Bermuda (HIAB) and pooled their strength to negotiate with Johns Hopkins.

"We have been able to achieve in Bermuda what most likely has not been achieved globally elsewhere,'' said Judy Panchaud White, president of the HIAB.

"That is, the unanimous support of the members of the Health Insurance Association to combine its collective bargaining power for the purchase of health care incurred outside Bermuda.'' But Mrs. Panchaud White also noted that the move was recommended as much as four years ago in the Oughton Health Care Report of 1995.

"The initiative to take such action was recommended in the Oughton Health Care Report of 1995, the Arthur Andersen Health Care Review and supported by the Ministry of Health,'' she said.

"We will continue to develop the relationship with Johns Hopkins and other top-rated medical facilities to ensure our clients receive medically necessary and quality health care overseas on a cost effective basis.'' Health Minister Nelson Bascome was on hand for the signing and called the move "a significant step forward in partnering between key players in the health care sector''.

He also noted Government's willingness to help foster other such alliances.

He said: "The Government also looks forward to sharing the benefit of these savings with the community by facilitating the redesign of insurance coverage to include services such as: patient education for example for asthma, cardiac and diabetes sufferers; home health care services; and improved insurance coverage of the elderly population.'' "In addition to working with the HIAB,'' he added, "the Ministry is working with physicians, the hospitals and other providers to assure quality care at the lowest possible costs for Bermuda's people.'' But Dr. Butterfield said the King Edward VII Memorial Hospital had other issues to address -- but one handicap was a cash flow problem caused by the insurance companies' payment methods.

Dr. Butterfield explained that insurance firms in Bermuda paid a daily rate, which was supposed to cover the bed and medical care -- and took a while to settle claims.

"There is no itemised billing for services like there is in the US and Canada,'' he said. "Here they try and guess what the overall cost is, which is not very realistic.

"There are a lot of things which need to be looked at in the healthcare service in general -- it shouldn't be done in a piecemeal fashion.''