overhaul and Bermuda will not be exempt from the changes, a hospital administrator revealed.

Sheila Manderson, executive director of the King Edward VII Memorial Hospital and St. Brendan's Hospital told Hamilton Rotarians this week the North American shift from in-patient to out-patient care has reached Bermuda.

"Bermuda is not exempt from concerns about escalating costs,'' Mrs. Manderson explained. "Perhaps the urgency has not reached the levels currently existing abroad, nevertheless, the issue is just as real here as our own percentage of gross domestic product of health care rises to double digit figures.'' Currently about 11 percent of the Island's gross domestic product goes to health care.

She pointed out that the hospital had been managing to `make ends meet' despite the fact that in-patient hospital reimbursements were not parallel to the costs of providing that care.

But she warned that a "serious'' review and revision of the incentives and reimbursement structures would have to take place if hospital services were to be maintained at the level people had come to expect.

Currently the hospital is working with consultants from the Arthur Andersen Group to develop a financial model that will allow for more accurate predictions of where health care funds are needed.

Mrs. Manderson told Rotarians that one area of great local concern was geriatric care.

"The hospital plans to expand its home care services to those elderly who are discharged home with family support,...'' she said, "and will provide more intensive rehabilitative services such as physical and occupational therapy to facilitate their mobility in preparation for earlier discharge.'' Mrs. Manderson also told Rotarians that the mandate for hospitals had changed -- "it has broadened to include responsibility for the health status, not just the sick status of a community''.

"Attention and health care dollars must be allocated to the prevention and wellness activities of education, appropriate screening and follow-up and reinforcement of healthy lifestyles,'' she said.

And she said that funds had been allotted to launch an Employee Wellness Programme to help hospital staff maintain good health.

The hospital, she said, will also be installing a new television system this winter to provide an education channel to inform patients about their diseases, treatment and care after discharge.

Mrs. Manderson also said a diabetes centre will be established in January, the new surgical wing will be completed in the spring and next month the first edition of a quarterly community newsletter, called Care, will be issued.

"While the hospital is responding to the call to diversify ... and devote some of its resources to maintaining and improving the health of the community,'' she explained, "it still has as its primary responsibility to care for the sick, to operate the acute care and mental-health hospitals in Bermuda.'' Mrs. Manderson also highlighted changes taking place at St. Brendan's Hospital including a major organisational restructuring.

And she reminded Rotarians that October 5 to 11 will be Mental Health Week in a bid to promote awareness on mental health issues.

HEALTH HTH HOSPITAL HOS