Health insurance became a controversial, sometimes distressful, topic towards the end of 2007 after a series of incidents exposed a mandatory insurance system failing some low-income earners in Cayman.
First there was the case of Kaloyan Kisyov, 20, who fractured his neck when he fell off a boat while enjoying a leisurely Sunday afternoon at Rum Point 16 September.
Mr. Kisyov, a Bulgarian national, was later flown to the University of the West Indies Hospital, where his medical bills quickly exceeded the $25,000 cap provided under his health insurance contract. Friends launched a fundraising drive as his hospital bills edged toward $100,000, while Mr. Kisyov battled for his life.
At last report Mr. Kisyov was on the improve in a hospital in his native Bulgaria. Community donations from across Cayman had enabled his family to pay off his substantial hospital bills.
Less than a week later, on 21 September, health insurance was back in the news after a driver of the No. 4 East End bus, Edwin ‘Eddie’ Edwards, crashed the bus into a tree on the Bodden Town Road.
Mr. Edwards was uninsured and could not afford the $130,000 deposit required at Jackson Memorial Hospital in Miami, a level one trauma centre. His employer, Dadford Dixon, said Mr. Edwards let his insurance policy lapse because he didn’t want to pay the premiums. Mr. Dixon rustled up what money he could and Mr. Edwards was transferred to a hospital in Jamaica but he died nine days later.
Superintendant of Health Insurance Mervyn Conolly later pointed out that responsibility for effecting and continuing health insurance lies squarely on the shoulders of employers.
Eleven days after Mr. Edwards’ crash, first-time Jamaican mother Shellesha Woodstock made headlines in Cayman and Jamaica when she gave birth aboard a Cayman Airways flight to Jamaica, after having being told by a HSA doctor that it was too expensive for her to deliver in Cayman.
A subsequent Health Insurance Commission investigation found that Ms Woodstock’s employer had let her insurance policy lapse. But her lack of health insurance was not directly related to the advice she received at the hospital, it was later announced, because staff there never checked whether her policy was valid.
With health insurance suddenly at the forefront of public debate, it was a timely coincidence that the Cayman Islands Insurance Association had scheduled a conference to look at Cayman’s mandatory regime of health insurance, 10 years after its introduction.
Mr. Conolly told the conference the HIC would push the Government to introduce stiffer penalties for employers that don’t provide their employees with adequate health insurance. Former Cabinet minister Roy Bodden went further, telling the conference government should consider nationalizing health insurance in Cayman.
Health Insurance Commission Chairperson Suzanne Bothwell indicated the HIC would be expanding its agenda in 2008 to look at problems such as portability of insurance policies; inconsistent positions taken by insurers regarding pre-existing conditions; insurance coverage for seniors; the failure of healthcare providers to complete claim forms for patients; and the failure of insurers in complying with filing obligations mandated under the law.
Ms Bothwell said the HIC would defy public perceptions that health insurance legislation in Cayman had no teeth by prosecuting employers that don’t provide health insurance. However Acting Senior Crown Counsel Trevor Ward acknowledged one of the problems with getting cases to court is that some ex-pats are afraid to report their employers for fear of losing their jobs.
This was followed on 8 November with an announcement from Leader of Government Business Kurt Tibbetts that immigration laws were being overhauled – in part to combat unscrupulous employers that don’t provide health insurance and other benefits to their employees.
Under the changes, employers will be required to prequalify with the Immigration Department before applying for work permits. The prequalification process will require employers to demonstrate that their business licensing is in order, and that they are complying with health insurance and pension requirements.
But just one day after Mr. Tibbetts’ announcement another tragedy would underscore the need for greater reform of health insurance in Cayman.
Premature twins born to a Jamaican woman at the Cayman Islands Hospital had died. The mother’s insurance policy did not cover the cost of transporting the babies off-island for the medical care they had so desperately required.
The 24-week-old twins needed to be transferred to a level three neo-natal intensive care unit. The mother’s insurance policy – again the standard policy with a $25,000 cap per incident of care – covered only a fraction of the $500,000 guarantee that hospitals in Florida and the Bahamas were asking for.
This tragedy led to claims of a ‘two-tiered’ system of healthcare in Cayman. Critics pointed to an unofficial policy in which it has been said government are providing financial guarantees to Caymanians requiring urgent overseas medical care but standing by and doing nothing when it is an expat that requires help.
Leader of the Opposition McKeeva Bush raised the issue in the Legislative Assembly, saying ‘we have these people working in our country and we have to find a way to deal better with it.’
At a press conference on the mishandling of Ms Woodstock’s case on 6 December, Mr. Eden defended the government’s position:
‘I invite those who have raised charges of a so-called ‘two-tiered system’ to provide the Ministry with examples of other countries, where non-nationals of those countries are provided by the host government with cover for incidents of catastrophic illness,’ he said.
While Mr. Eden defended this position, there were indications at the press conference that Cayman’s health insurance regime would be receiving a shot in the arm
Mr. Conolly, who was at the conference to report on the findings of a HIC investigation into the incident, said the commission would be recommending that the Ministry increase the scope of benefits provided for in the standard insurance policy required by law.
But he said there had to be a balance between increasing benefits and ensuring premiums didn’t rise too much.
For his part, Mr. Eden indicated there would be changes to Cayman’s system of healthcare announced in January, but did not specify what the changes would be.
Meanwhile, Honorary Jamaican Consul, Robert Hamaty, who had lamented in the later part of the year how health insurance was failing low income earners – particularly Jamaicans – began looking for an answer of his own.
He asked an insurance company to conduct a feasibility study into establishing a collective medical fund for low income earners that require emergency treatment off-island.
Although the Jamaican consulate would not be responsible for administering such a fund, Mr. Hamaty said he envisaged it being available to Caymanians and non-Caymanians alike.
In the New Year, many low-income earners will be looking to the Government to show similar initiative to tackle a difficult but deadly problem. The Caymanian Compass will be closely monitoring developments too.