yesterday.

And Dr. Ewart Brown urged Government to act before the sickness becomes terminal.

He was speaking as MPs debated changes to hospital insurance, designed to allow more flexibility to allow services usually provided by King Edward VII Memorial Hospital to be provided outside by hospital staff.

Finance Minister Grant Gibbons , who introduced the Hospital Insurance (Standard Hospital Benefits) Amendment Order, said a third of all King Edward beds were filled with people who could be treated outside the hospital.

And he added that the length of hospital stays in Bermuda had increased, while elsewhere the figure was going down.

Dr. Gibbons said: "We should be promoting care outside hospital, not just on a cost basis, but on a care basis as well.'' But Dr. Brown, who admitted he ran a private medical practice, said $40 million-plus of taxpayers money was pumped into the hospital system each year.

And he said he had warned then Health Minister Quinton Edness in 1988 that problems were on their way.

Dr. Brown said: "The cost of health care is driven up exponentially when the focus of care is the hospital.'' And he warned health care in Bermuda "faced a mixed bag of ailments'' -- including a "very cumbersome, bureaucratic'' system of funding.

And he said the taxpayer forked out for "the only show in town'' -- but a show which did not run efficiently.

Dr. Brown said: "We must make certain fundamental changes in the health care system, not just the hospitals.

"The hospital has no incentive to be efficient...'' And he said insurance companies are "allowed to make decisions arbitarily, without any accountability at all''.

He added it was also "a mistake'' to assume hospital standards were high -- and pointed out hospital mistakes were generally more costly than out-patient ones.

Dr. Brown said it was time to "force the hospital to be efficient''.

He added: "I urged this Government and the Finance Minister, despite any obstacles which might be in his way, for the insurance industry to be held accountable for what they say the insurance companies will pay for.

"Health care is more expensive when you provide it in a hospital -- it's less expensive when you provide it outside a hospital and I urge this Government to take note of that fact.'' The Act -- which passed the House -- gives the Hospital Insurance Commission the ability to approve hospital services provided outside.

Dr. Gibbons told MPs: "The proposed amendment will provide the Commission with the ability to approve hospital services provided outside of the hospital by hospital staff, provided it is satisfied that certain standards of care are met.'' He added: "In the coming months, I will be discussing with the Hospital Insurance Commission ways of allowing them the ability to further approve hospital services provided outside the hospital by non-hospital staff.

"As Honourable Members will recall, the Government's healthcare review identified the significant cost benefits of providing home healthcare and the proposed amendment will help facilitate such a development, while providing for the ability to control the quality of care given.'' Government Whip and former Health Minister Quinton Edness said the hospital was "wonderful...but not perfect''.

And he said taxpayers were pumping $29 million into hospital services for the current financial year.

Ottiwell Simmons (PLP) pleaded: "With one solitary hospital in Bermuda, we really must make sure that we get it right.

"Not only administratively, but with regard to subsidies and in the event that Bermuda should suffer a catastrophe of any kind.

"This bill is preparing the groundwork so that if there is more home care or treatment outside hospital, there is provision for services and care to be regulated and provided for.'' He said healthcare costs were "too high and escalating rapidly''.

Dr. Gibbons agreed that the costs of health care outside hospital had to be supervised.

But he denied Dr. Brown's allegation the hospital was "sick'' -- and said new Health Minister Wayne Furbert would soon announce new measures to provide home care services.

The costs of hospice care and diabetic counselling will be shifted from the Mutual Reinsurance Fund to the standard plan, after the amendment order passed yesterday.

Insurance companies will now have to pay annual licence fees of $550, instead of $500, to have their policies officially approved.

And five approved healthcare schemes run by employers -- Bacardi, American International, Bank of Bermuda, Cable and Wireless and Government Employees Health Insurance -- will now incur annual licence fees of $400, instead of $350.