clampdown.

Insurance companies say residents are leading Bermuda into a US-style health crisis, with costs zooming out of reach of ordinary people.

Tighter rules are needed to stop abuse of the system, they say.

Major firms are bringing in a system of doctors' second opinions to cut "unnecessary'' trips abroad.

Companies are also increasing premiums by around 20 percent to cope with a boom in costs both overseas and at home.

The clampdown will be officially announced next week by the Health Insurance Association of Bermuda, to which firms like BF&M and Somers Isle Insurance belong.

It follows official alarm over an increased number of people seeking routine treatment abroad, which has helped cause a 92 percent rise in overseas claims costs since 1989.

It is feared Bermudians may be going abroad for help because of a lack of faith in King Edward VII Memorial Hospital.

"We try to be as generous as possible when people are forced to go overseas for treatment that is unavailable here,'' said Mr. John Sainsbury, MD of the Argus group, which includes Somers Isle, the Island's largest health insurance firm.

"Generally speaking, that gets bordering on 100 percent coverage. "The other extreme is people who could perfectly well have the treatment here through the perfectly adequate facilities, but choose to go abroad for one reason or another -they are going on vacation or may not have `faith' in the local system.

"We can't stop them, but they will participate more in the cost. We will pay 75 percent and they will pay 25 percent.

"They are better off financially having the treatment in Bermuda.'' Hospital tragedies happen everywhere, said Mr. Sainsbury, but local people felt more affected because Bermuda was so small.

He admitted "some people are going to be not so happy'' with the clampdown.

"But in the long term it will tighten up the system and continue to make health care affordable.'' Most major firms made a loss last year or just broke even, he added. Another industry insider, who asked not to be named, told The Royal Gazette : "We have to try to get some control over this situation because otherwise Bermuda's insurance costs are going to go through the roof.

"The costs in the US, at least on the Eastern seaboard, are at least five times what they are in Bermuda.

"It's a question of how much we want to import these levels of costs into Bermuda by going overseas for treatment.'' The HIAB says it wants health officials to help control "spiralling'' overseas health costs.

It wants them to: Boost the number of visiting specialists providing necessary, but non-emergency, consultations or surgery.

Buy more hospital equipment, if cost-effective, "to reduce the need for people to travel abroad''.

Cut overseas costs by arranging for "reputable'' foreign hospitals to be "preferred providers''.

Mr. John Sainsbury.