Cardiology tops overseas care for civil servant insurance

 Cardiology has been the number one cost for sending government employees and retired civil servants overseas to get medical care for the last three years according to annual reports.

In the 2005/06 fiscal year, the government insurance company spent nearly $2 million on civil servants and retired government workers for cardiology treatments at overseas facilities. The bulk of these cardiology costs were spent in US hospitals, where medical costs are the highest in the world.

Over the next two years, cardiology costs jumped to nearly $3 million in spite of special agreements with US hospitals.

A factor behind the large number of cardiac patients sent overseas is there is no cardiac catheterization laboratory in the Cayman Islands, according to Cayman Islands Hospital medical director Dr. Greg Hoeksema.

Whether or not the country’s population is large enough to establish a cardiac cath lab has been a controversial subject among the medical community for years with several doctors falling on both sides of the issue. The debate over bringing a cardiac cath lab on island has questioned whether the approximate 60,000 population is sufficient to justify having one, especially when cardiologist surgeons must perform a certain number of procedures each year to maintain their skill levels.

However, Dr. Hoeksema categorically stated there is definitely enough population to justify a cath lab. He estimated a state-of-the-art cath lab would cost between $2 to 3 million to bring on island. The costs of sending government workers and pensioners alone overseas for advanced cardiac care has been close to $3 million in recent years. And that is without adding in the costs private insurance companies spend to send their cardiac patients overseas, said Dr. Hoeksema.

“It seems intuitively obvious that we should have a cardiac cath lab on island,” said Dr. Hoeksema. “State-of-art cath labs today are unbelievably safe. About 95 per cent of the patients could be done safely.”

With appropriate screening of patients, the mortality rate is very low, added Dr. Hoeksema.

In recent months, top officials at both Health Services Authority and the Cayman National Insurance Company have indicated there were efforts in the works to establish a cardiac cath lab, including a fulltime cardiologist surgeon. But with government’s current financial crisis, it may take a little longer to come up with the upfront capital to bring one on island, said Dr. Hoeksema.

Health Services Authority is now looking at ways to do a public/private partnership to finance a cath lab, using the newly set up hospital foundation.

Bottom line for overseas
Government’s total cost for overseas medical care has essentially doubled over three years from $7 million to $13.6 million for 2007/08.

Cardiology, cancer, trauma and premature babies accounted for more than $8 million of the $13.6 million of overseas costs.

Although the number of people with CINICO coverage increased by 14 per cent over two years, the growth did not account for the doubling of total medical care costs over the same period.

CINICO’s 2007/08 annual report contradicted Dr. Hoeksema’s statement about the population base and top medical issues.

“With a population of approximately 50,000, there would not be the demand for certain advanced services in cardiac care, cancer care and neonate care to justify the massive investment and maintenance. We must send some patients overseas for medical care…These realities are expensive, but also a fact of life,” stated the report.

CINICO insurance for civil servants and retired government workers is considered to be one of the most generous with benefits in the country, particularly for overseas care. When it is determined the patient has to be sent overseas for specialised care, those costs are covered at 100 per cent, according to CINICO benefit plan for civil servants and retirees. Moreover, there are no limitations for pre-existing medical conditions such as a heart condition or cancer that would automatically be exempted when signing up with most private insurance companies.

With 13,500 total people insured under some type of CINICO plan, government’s insurance company covers the largest number of people in the country. Of the 13,500, some 10,000 being civil servants and retirees have the full coverage benefits, accounting for the bulk of the overseas medical costs.

Another factor behind the rising costs is there are not enough specialist doctors or facilities available in the Cayman Islands to treat complicated medical issues.

“Our overseas usage is far greater when specialists are in short supply,” says CINICO general manager Carole Appleyard. “We need an additional physician complement at the George Town Hospital.”

Government’s dependence on the US for overseas health care is also driving up costs, according to CINICO’s annual report.

The report stated: “The US is the most expensive global health care destination, spending on average close to 16 per cent of their GDP on health care. Within the US, Florida is the third most expensive state to receive health care. Being located close to Florida is not beneficial to minimizing costs.”

Cancer treatment has also accounted for a big chunk of the total overseas costs, fluctuating between $2.3 million and $1.6 million for the fiscal years 2006/07 and 2007/08.

Neurology treatments, primarily trauma injuries such as car wrecks and accidents, are also among the top health care costs for overseas care.

Premature babies
US costs for treating severely premature babies can be particularly expensive. Over the last few years, overseas expenses for severely premature babies have varied, ranging from $425,000 to $2 million. For the last fiscal years, two overseas cases for premature babies totalled $2 million.

CINICO has been able to obtain some negotiated rates with certain US hospitals, according to Appleyard. Many cancer and vascular surgery patients are sent to Mt. Sinai for treatment. Trauma patients are sent to Jackson Memorial Hospital, and cardiac patients are sent to Baptist Health.

The hospital is also working on getting more advanced care for the other top medical issues, said Dr. Hoeksema. It has already used the visiting neurosurgeon at Chrissie Tomlinson for a few surgeries at the Cayman Islands hospital and they are looking to work with the Cancer Society to add chemotherapy to the island.

Currently, the Cayman Islands Hospital is rated to treat premature babies at 28 weeks, which is excellent. But hospital management is evaluating what needs to be done to safely treat premature babies at 26 weeks, said Dr. Hoeksema.