People usually look forward to their retirement, counting the days until they can hang up their work clothes and put their feet up.

But occasionally the sudden change in life can be such a shock to their system that their health, both mental and physical can deteriorate.

At such a time, the stresses on family life can be great, and even more so when people realise the company health insurance which they paid in to each working month without fail, is at an end.

During your working life, your premium goes out, your employer makes his contribution, and if you are lucky you don't need to make a claim, but if you do, you do so in safe in the knowledge that you are covered for most eventualities.

Many of the larger employers make arrangements to keep their over 65s on the health care scheme, whereby they still a contribute, but far less than they would to start a new scheme at retirement age.

Those who aren't covered are faced with the choice of starting a private plan with a company such as Colonial Insurance or BF&M, or rely upon the standard Government Health Insurance Plan or take the chance of having no cover.

But geriatric specialist Dr. G.B. (Bert) McPhee feels there is a clear case of the haves and have-nots.

"If people have no insurance cover then they have to stay with the HIP, which has been gradually rising and people find it hard to make that,'' he said.

"Somebody who is getting a pension ranging from $200 to $700 a month, you can imagine how that would work out.'' A recent survey by Age Concern in Bermuda revealed that the two major issues facing seniors are loneliness and health, and there is the likelihood that health could become the No. 1 issue when you consider that expected lifespans for men and women are now 75 and 80, respectively.

Age Concern coordinator Janet Jackson says even those on a high income can find it hard to manage, especially when they come to consider items that their health insurance doesn't cover.

"Because of the cost of seeing the doctor, many put it off and then find that they have to go in to hospital because they put it off,'' she said. "A lot of them say `I should have been here a long time ago, I was hoping it would get better' -- they were worried about the cost when they should have been getting well.'' But even as a two-tier health care system develops, those who "have'' may also find themselves in financial trouble when a heart attack or stroke, for instance, means they need long-term care, but their health care plan will only cover them for a limited period, said Mrs. Jackson.

Health insurance problems aside, with an ageing population that is destined to place increasing demands on the health service, Dr. McPhee believes Bermuda just isn't equipped to cope with those pressures.

Paying for those services will provide a taxing time for both residents and employers.

Where some larger employers keep their workers on the health care roll, rising costs may cause them to re-think that strategy, possibly leaving hundreds without a health safety net, said Judy Panchaud-White of health insurers BF&M.

"There may be a tendency to keep retirees on the group health plan, however there is a cost to active employees because what tends to happen is that the retiree's cost is averaged out over the whole population.

"Employers pay a higher rate to help subsidise the cost of the over 65s, but this is going to become a more of an economic factor with employers going forward, because of the ageing population,'' she said.

At present there is an employee to retiree ratio of 18 to one, but with population projections for 2030, this rises to up to three to four workers supporting one person over 65.

Those statistics alone may convince employers to reconsider their health insurance plans for their retirees. Especially since health care costs for the over 65s are likely to be three to four times higher than those for someone aged 35.

And they may also have been one of the reasons behind the possible planned legislation that could require people to save for their retirement.

This legislation, which is expected to be enacted this year, broadly requires workers to put aside up to ten percent of their salary in an investment fund, which on retirement is put into an annuity, providing monthly income which will cover costs such as health care.

Health Minister Quinton Edness said in the short term there may be a rise in pension payments.

He said Government recognised that seniors suffer very high health care costs, including those for drugs and doctor visits, and the review may address some of these issues.

But until then, those who find themselves without health care cover can either apply for a private plan or join the HIP.

Private insurance with cover for major illness and surgery could run to $700 a month for a couple.

The Government plan is considerably cheaper, but only provides a minimum of cover, which is adequate for services at the King Edward VII Memorial Hospital but not for those patients who require treatment overseas.

The number of days patients requiring acute care spend in hospital has declined in the last five years -- but the days that extended care patients have spent in hospital has increased steadily: Acute Extended Care Care 1993 63,905 34,509 1994 65,573 36,379 1995 63,132 36,765 1996 62,271 36,924 1997 62,682 37,091