"It is a report that should not be put on the shelf. Where possible, it's recommendations should be put in place,'' Community Affairs Minister Sen.

Yvette Swan said.

Sen. Swan said that while Bermuda's health care system is good, there is room for growth.

Among its many recommendations is the suggestion that a Bermuda Health Council be formed to integrate all health services.

She agreed with the integrating and standardising of health care but that care must be exercised on if medical professionals' fees would be handled under the Council.

Sen. Larry Scott (UBP) called the report a "strategic plan'' for Bermuda's health care system.

He also said that there is a need for some Bermudians to receive health care services abroad and that practice has eroded profits Bermuda insurers.

Sen. Milton Scott (PLP) said he was not in favour of a Bermuda Health Council as ensuring the Country had adequate health care was Government's responsibility.

"Government has to ensure that is done,'' he said.

He praised the report's observations that employers, unions and individuals needed to take a more active role in promoting good health and that patients should require referrals before going overseas for treatment.

He said the review also highlighted the Island's need for more visiting specialists as patients were forced to wait for long periods of time before they could get an appointment.

This sometimes led them to go overseas, he noted.

And he called for an individual to oversee all treatments received overseas by local patients which could prevent them from being ripped off.

He added that a skilled individual would also be able to negotiate with overseas facilities about lowering costs for patients.

Sen. Scott said he felt it was good that anyone requiring treatment at the hospital was not turned way but noted that the hospital credit manager should not be the person declaring whether or not patients were indigent.

"This is like putting the sheep in with the wolves,'' he said.

The temptation would always be there for hospital personnel to simply declare patients were indigent without looking at the full picture.

He suggested legislation be brought forward to ensure everyone was insured to a certain standard and a system be installed which would properly determine whether people were indigent or not.

Sen. Scott looked at the section of the Health Care Review which dealt with prescription drugs.

He said he felt the recommendations here were excellent particularly those suggesting people become better educated about the subject and about healthy lifestyles.

But he also noted that the Island had not bought into the idea of generic drugs completely yet which was a shame as these were cheaper alternatives to brand name pharmaceuticals.

And he said he was concerned with a recommendation in the review that suggested Government dispensaries be privatised which he felt was not necessary.

Sen. Scott said he approved of the idea of home care for senior citizens and added that this should be a standard medical benefit.

He suggested that health service providers for adolescents be put in a non-threatening environment where their services were more likely to be used.

There were too many school-age mothers walking around the streets, he said.

This was not just an issue of values or morals, he stressed, but a public health issue also.

Sen. Scott said flexi-hours for service providers was another good idea as there were people who needed treatment but could not get to offices during the hours they were open.

He said he was also concerned about the number of unqualified people working in the Island in the field of psychology and said legislation to regulate this needed to be forthcoming.

He praised the review for acknowledging the need for a "six to eight bed child and adolescent in-patient facility'' with an adjoining classroom.

"Where is it?'' he asked. "I have been recommending this.'' Sen. Alf Oughton (Ind), who chaired the review, stressed that the main objective of the review was to assess the present status of Bermuda's health care system and see what the future held.

And looking at the system, he continued, he was alarmed about the Island's future if things kept going at their present rate.

But there was no need to rush out and start putting the recommendations in place straight away, he added.

However the Island should start doing something over the next five years or so, he said.

One reason for health care costs going up, he noted, was that "Bermudians want the Rolls Royce of everything''.

Now patients were telling their doctors what expensive treatments they wanted -- which they often did not need -- and some doctors were simply giving in to them.

Sen. Oughton moved to settle some of the distress the suggestion of a Bermuda Health Council had caused.

The council was not intended to be a privatised organisation, he pointed out, which is what it had been anticipated to be.

He said what was being proposed was quite common overseas and its primary purpose would be to act as an umbrella group for heath care providers and administration.

These stake holders in the council needed to be well managed and well structured, not fragmented like the present health care system.

Sen. Oughton said senior representatives of these stake holders had either sat on the committee which conducted the review or were consulted for their opinions.

He added that a consensus had not been reached on the subject as two of the groups involved recognised they needed an umbrella group but could not agree on how it should be formed.

These were the Department of Health and the Bermuda Hospitals Board.

He said he believed their concerns arose from their fear of losing the individual authority they presently enjoyed.

But under the council they would continue to have the same functions they did now, he said.

The council would have the responsibility of continually monitoring and reviewing the health care system, co-ordinating all the service providers and reporting to Government its findings.

He said it was proposed that it be funded by the mutual reinsurance fund which he said needed to be better utilised. In turn, insurance premiums would be raised by an additional 87 cents to cover the expense.

The council would take a while to implement, continued Sen. Oughton, but in the meantime there were other recommendations which could be put in place.

There was no intent of Government mandating doctor's fees, he stressed.

The review had recommended that a schedule of fees be set up and this was already done within the hospital, he said.

Sen. Oughton said he felt that if the Island was to start moving in the right direction then an outside group should be brought in to take the recommendations and run with them.

But this group was not available in Bermuda at the present time, he added.

Sen. Walwyn Hughes (Ind) said Bermuda was not the only Country which had to do something about its health care costs.

And he stressed that something had to be done sooner rather than later even though the Island had a health care system which was recognised as a good one.

But even a good system needed to be enhanced and kept current, he noted.

Sen. Hughes said one dominant theme in the review was the impact on health care that the Island's aging population would have.

This was only a step away from the problems being seen with pensions, he added.

He said he heartily endorsed the idea of home care. There was nothing worse than growing old and thinking that you would go to a home instead of staying at home, he added.

And he said with effort, ways to cover the cost would be found although it would be difficult in the era of the nuclear family.

Sen. Hughes admitted that he was not clear on the idea of the Bermuda Health Council and said he agreed with Sen. Scott who believed that Government had the ultimate responsibility for health care.

It could not pass this onto another agency, he warned.

Sen. Pitman focused his comments on Bermuda's aging population because it will a large affect on health care costs.

There were a number of recommendations regarding the elderly, including making home care an insured benefit, he said.

"The cost of caring for Bermuda's elderly population is an ever-increasing one.

"I'll do everything I can to make sure this report does not sit on the shelf.''