There will be no changes to the maximum benefits of the standard health insurance contract before the next election.
Health Minister Anthony Eden finally acknowledged failings with the legally mandated plan during an address to the Legislative Assembly Thursday, but he offered no solutions on how it can be fixed.
‘There is a general consensus that the current level of healthcare benefits listed in the Standard Health Insurance Contract is not in line with today’s costs,’ Mr. Eden said.
‘However, I caution that any legislated increase in benefits will be matched with increased cost of premiums for employers and employees.’
Mr. Eden acknowledged that the Health Insurance Commission had last year called on his ministry to improve benefits offered under the plan.
As a result, he said an actuarial report was commissioned to work out what effect increased benefits would have on insurance premiums.
The report concluded: ‘The expanded benefits under the new plan would lead to significant increases in premium rates and the segment of the insured population that would be most affected by the premium increases are persons inured only for SHIC1 (those on the basic plan).’
But the Caymanian Compass can reveal that a report addressing similar issues was already available when Mr. Eden took over as health minister after the May 2005 elections.
The report, obtained by the Compass, was carried out by CHF Performax, a Texas-based healthcare consultancy after former Health Minister Gilbert McLean requested a review of the legally mandated health insurance plans.
The report contradicted Mr. Eden’s claim Thursday that increasing health insurance benefits will lead to higher premiums. It stated: ‘Adding or eliminating a specific covered service or benefit from a plan had very little effect on price. The level of policyholder co-insurance and deductible, on the other hand, had a significant effect on the cost of the plan.’
Instead, it argued that a lack of flexibility in Cayman’s mandatory health insurance system was stifling competition, driving premiums higher.
Addressing legislators last week, Mr. Eden insisted the issue of affordable healthcare insurance for all remains high on his Ministry’s agenda.
But he offered no new details on whether the Ministry of Health has any plans in place to change the basic plan of health insurance benefits employers must provide their workers.
Instead, he referred to a long-touted plan to offer more services from Cayman’s district healthcare clinics – possibly free-of-charge to Caymanians – and suggested this will have a knock-on effect on health insurance costs.
‘Simply increasing health insurance coverage or providing social assistance is not the answer,’ he said.
‘[The Ministry] is not looking for quick fixes, but instead we want to find solutions that will put social development on par with our islands’ physical development.’
Mr. Eden emphasised that mandatory health insurance was introduced to ensure access to on-island care.
‘It was never meant to cover catastrophic care overseas, but provide people, at the very least, access to inpatient services at our local hospitals.’
That comment will likely provide little comfort to the family and friends of Carol Romero, the 32-year-old Blockbuster Video employee that died in a Honduran Hospital in February. Her life depended on urgent off-island medical care and she had only the basic health insurance plan to pay for it.
Ms Romero, a Filipino work permit holder, was hit by an allegedly drunk-driver outside the Grand Harbour Shopping Centre on 21 January.
She was transferred to a private Honduran hospital after centres-of-excellence hospitals in Florida proved too expensive and attempts to transfer her to Jamaica and Cuba also failed.
After an almost month-long battle, Ms Romero had been showing signs of recovery at the private Cemesa Hospital when insurance funding for her treatment ran out. She was then transferred to a public hospital, but died three days later on 20 February.
The Compass’ report on her death has reignited debate over inadequacies with the standard health insurance contract, as well as Cayman’s so called two-tier system of healthcare, under which government guarantees overseas medical care costs for Caymanians, but not for expatriates.