Health fees under scrutiny

Health insurance fees in the Cayman Islands are about to go under the microscope.

The Ministry of Health announced last Friday the launch of its Standard Health Insurance Fees 2006 Revision Project.

The project will take another look at health insurance fees and standardise the amounts that health insurance companies have to reimburse healthcare providers.

The new standard fees will not represent the fees that healthcare providers will charge, however.

The Standard Health Insurance Fees lists descriptive terms, identifying codes and the reimbursement amounts for about 7,500 medical procedures. These codes are called Current Procedural Terminology.

The project is a joint project with Kroll (Cayman) Ltd., which was represented at the conference by Mr. G. James Cleaver. Kroll Cayman Ltd. Was formed in early 2005 when Ernst and Young was restructured.

The list will be available through the Legislative Assembly or online at www.hic.ky.

An important aspect of this project, however, is the in-depth analysis of actual healthcare costs.

‘We are most excited about looking at the true cost of providing healthcare in the Cayman Islands through a detailed survey that will take place,’ said Chief Officer of the Ministry of Health and Human Services Ms Diane Montoya.

Prior to 2005, the individual insurance companies would decide how much they would pay back to the healthcare providers, she said.

Insurance companies complained at a recent HSA forum they couldn’t ensure the costs healthcare providers were charging were accurate.

This new project will aim to appease both sides. As for patients, there is no guarantee that premium costs will be adjusted by this new project.

However, should any insurance company wish to increase its premiums, there has always been a monitoring system in place, said Mr. Mervyn Connolly, chief executive officer of the Health Insurance Commission.

‘They have to file their premium rates with us, and if they request an increase in them they have to apply to the commission with justification,’ he said.

It seems that all stakeholders in the health insurance issue have been pleased with the project and are working well together, said Minister of Health Mr. Anthony Eden.

‘Non-Government Organisations are required to comply with Government’s new financial requirements, which are based on output budgeting,’ said Mr. Eden.

In return, the Ministry will continue to promise their financial commitment.

‘The Ministry recognises the vital role NGOs play in the growth of the community,’ he said.

This combining of the private and public sectors is essential for creating a world-class health service in the Cayman Islands, Mr. Eden said. ‘If we look at what the Cancer Society has just done, this is a great example of what we need to encourage here.’

The Cayman Islands Cancer Society just purchased a $300,000 mammography machine without any funding from the Ministry, by raising money from the private sector.

Some of the healthcare issues also being addressed by this project include over-utilisation of the services, said Mr. Connolly.

‘We don’t want to discourage people from going to the doctor if needed, of course not,’ he said.

‘However, we do aim for people to gain better health through lifestyle changes and preventive methods.’

Ms Montoya explained that steps are being taken to see if Public Health Services will expand their public health programmes.

‘We should have a consultant coming down in a few weeks to see if we need to increase the capacity (for public health programmes),’ she said.

The first Standard Health Insurance Fees document was developed by Drs. Hann and Akoto and the Health Insurance Commission, in consultation with the Cayman Islands Medical and Dental Society and a special committee of the Cayman Islands Insurance Association, said a press release from GIS. These fees are to be revised annually.

Upon approval by the Governor in Cabinet and after consultation with the Health Insurance Commission, the revised Health Insurance Fees that are to be paid by approved health insurers will be published in the Cayman Islands Gazette.

The Standard Health Insurance Fees project will aim for completion by late July, said Mr. Cleaver.

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