that it did in the property and life sectors, a guest speaker at the Bermuda Insurance Symposium II said yesterday.

A possible mechanism may be a centre of cost benefits analysis to address the growing price tag of health care in Canada and the US, said associate professor of strategic management and ethics at the University of Ottawa Dr.

Jane Fulton.

"The insurance industry has to show the public there is value for money.

Major US health insurers risk losing the profitability of that market,'' said Dr. Fulton, who has served on several health councils provincially and federally in Canada.

The US has the most expensive health care system in the world while Canada has the second most expensive and costs for governments, the private sector and insurers continue to rise, she said.

In the US, 50 percent of the cost of care is funded by government with the remainder covered privately while in Canada the ratio is 70/30, she said.

"If I could single out one area for reform that would improve the American system I'd chose the insurance component. America already has superb health care. It just doesn't get to people quickly enough and the right people early enough,'' she said.

"Health care insurance premiums are about money and profit, not about health care,'' she added. "Health reform in the future will be about spending smarter while spending less. Spending more money on health care does not necessarily result in a healthier population.'' European nations and Japan have achieved higher health status indicators and spend less on health care than the US or Canada.

She estimated about $20 billion of the approximately $65 billion spent yearly on health care in Canada comes from the insurance industry.

Health care premiums will drop when risk drops, she said.

"Insurance companies have the clout, they need to pay more attention to health care.'' She predicted huge changes in the number of health care insurance companies.

By the year 2000 there will only be only ten health insurance companies operating in the US and only 25 worldwide, she said.

The insurance company that offers value added service and formed a partnership with the marketplace could take the whole market.

Dr. Fulton, author of two books on health care and co-author of another on the same topic, was also a member of US First Lady Hillary Rodham Clinton's task force on health care reform.