An end to the months long "Mexican stand-off" between local physicians and health insurers may now be in sight as Parliament passed an amendment yesterday granting Health Minister Nelson Bascome the power to step into the row and set a fee schedule for both parties.

The Bermuda Hospitals Board Amendment Act 2002 gives the Minister the ability to set a fee schedule when the two sides of the health care equation cannot come to an agreement.

Doctors and insurers have been battling for more than six months over a new fee schedule, which was needed when both sides agreed to abandon the Bermuda Relative Value System (BRVS) of fee coding for in hospital procedures.

While both sides agreed to move to an alternative coding system, doctors wanted thousands more procedures covered in the fee schedule than insurers were willing to agree to.

Despite the parties being sent to mediation and having extensive meetings with the Health Ministry, doctors and insurers have been unable or unwilling to reach an agreement.

Without an agreed fee schedule in place, many physicians began billing patients directly for treatment despite them having update health insurance policies.

"This didn't bode well for the general public of Bermuda," Mr. Bascome said in introducing the amendment yesterday. "That's why we are here today."

Mr. Bascome pointed out Colonial Insurance and General Health Insurance (GHI) were not affected by the current impasse.

And, he said, some progress was made over the many months of negotiations as doctors and insurers had agreed of fee schedules for anaesthetics and medical procedures.

But the two sides failed to agree on fees for surgical and obstetric procedures at the hospital.

"At this point, they are not even working together," the Minister said.

The amendment passed yesterday will allow the Minister to set the fees and it will be mandatory that both physicians and insurers respect them.

However, while Opposition MPs welcomed an end to the long impasse, the amendment fell under harsh criticism for not specifying that the Health Minister must develop the fees in consultation with stakeholders.

UBP MP Kim Young said the Minister had no particular expertise which would allow him to better set the fee schedule than stakeholders while her colleague Shadow Legislative Affairs Minister John Barritt pointed out that the wording of new legislation no longer compels the Minister to consult with physicians and insurers.

Mr. Barritt said, casting an eye to the future, the amendment should be changed to indicate the Minister "shall" consult with stakeholders - rather than "may" - or add a provision that the schedule be subject to Parliamentary scrutiny.

As it stands, the fee schedule need not be debated or approved by the House, Mr. Barritt pointed out.

Opposition Leader Dr. Grant Gibbons said he considered the amendment to be a "knee-jerk reaction" to the "Mexican stand-off" which might have been avoided, had Government taken action years ago as was recommended by the Arthur Andersen review of health care.

Mr. Bascome and his colleagues Transport Minister Dr. Ewart Brown and backbencher Delaey Robinson dismissed these criticisms, however.

Speaking as a physician, Dr. Brown said doctors and insurers have fundamentally different perspectives on health care and it was imperative that Government step in for the benefit of the general public.

"Government has demonstrated firm and fair leadership in the absence of a resolution by the stakeholders," Dr. Brown said. "It is a duty of Government to move to protect the interests of the people."

And, he said, while Mr. Bascome has no direct knowledge of health insurance issues, he has a number of resources to call upon in helping him arrive at a fair, fee schedule.

"That is no different that any Minister going about his duties," Dr. Brown said.

Mr. Robinson suggested that Government's actions have the effect of bringing a previously silent stakeholder in the row - the patients - back into the equation.

While a number of Opposition MPs verbally objected to the amendment, the bill passed the House in the morning session.