Civil servants said to have ‘entitlement culture’
Free, unlimited healthcare for
Cayman’s civil servants is unsustainable and needs to change, a health forum
attended by the major players in the local health industry heard last week.
Canover Watson, chairman of the
Health Services Authority board, described an “entitlement culture” among civil
servants in regard to free healthcare.
“There is no incentive or
motivation right now for the civil service to change… It is going to take
political will and a lot of political capital,” said Mr. Watson, adding that
since the civil service is the largest voting block in Cayman, changing the
status quo of free medical care and health insurance for civil servants would
be a political risk for the government that tackles the issue.
Chief officer of the Ministry of
Health, Jennifer Ahearn, pointed out that the sense of entitlement toward
healthcare is not just among civil servants, but also among members of the
general population who fail to get adequate insurance coverage and who then
insist on being sent, for example, to Baptist Hospital in Florida rather than
to a hospital in Jamaica.
“There is a pervasive expectation
that “if I have not taken responsibility to get sufficient health insurance,
this government is going to fix it for me… The expectation of the patient is
they will be going to Baptist, even though they have not taken out insurance.
There is this entitlement, it’s not just centred in the Civil Service, it is
across the board, and the HSA has to deal with it every single day,” she said.
Currently, the government pays
health insurance premiums for public servants to the Cayman Islands National
Insurance Company, or CINICO, and that provides 100 per cent coverage for civil
servants, their spouses and families. CINICO also covers indigent members of
the community who cannot afford health insurance or do not have any, as well as
the under-insured, seafarers and veterans.
“Fundamental attitudes and behaviours
have to change. The entitlement culture has to be addressed,” said Mr. Watson,
at a healthcare forum at the Ritz-Carlton on Thursday, 20 January.
Ken Di Bella, president and CEO of
health management company CBCA Administrators, organised the Cayman Island
Healthcare Thought Leaders Forum at which he and other speakers introduced several
suggestions they said could cut the cost of health care in Cayman.
Eliminate the ‘middle man’
One approach put forward was to get
rid of the “middle man” – the third party administrators that find hospitals
and specialists overseas to treat Cayman residents who cannot, or in some cases
choose not to, get treatment locally. Other suggestions included creating
incentives for an aggressive approach to preventing chronic illnesses, such as
diabetes, heart disease and hypertension, and the adoption of technology that
keeps healthcare providers in closer contact with their patients.
Kelly Burn, a healthcare consultant
invited by Mr. Di Bella to speak at the forum, described savings that could be
made if CINICO and the Health Services Authority developed its own network of
hospitals and medical centres overseas to which patients would be sent, rather
than using or “renting” networks developed by a third party.
She said this approach would not
only lower the costs of sending a patient overseas for treatments because a
third party would not have to get a cut, but also could generate revenue for
Cayman because other health services and insurance companies could then pay to
use the network created by Cayman.
James Watler, president of the
Civil Service Association, questioned how CINICO had found itself in a
situation in which it was paying for third parties to send civil servants and
other patients overseas. “I am appalled to see where it is today… we should
never be in this kind of financial dire straits, being held hostage by the
middle men out there,” he said.
“Somewhere along the line,
somebody… derailed the intention and we find ourselves in this high-cost
environment where CINICO has to call Canada or Russia or Timbuktu in order to
say where somebody can go from the Cayman Islands. That is ridiculous. We have
said over and over that we need a better structure, we need to go back to plan
one,” he added.
Some participants questioned how it
would be possible to economically have incentives for regular health screenings
and other preventative measures for chronic illnesses for civil servants and others
who do not pay for their own insurance premiums.
CEO of the Health Services
Authority Lizzette Yearwood said that discussions are under way with various
partners on how to implement a programme that would lower costs for CINICO and
be welcomed by civil servants. “We cannot continue on the way we are going, we
have to do something,” she said, adding that incentives might include some kind
of points systems for CINICO members if the insurance company’s spending was reduced.
But Mr. Watler said the Civil
Service Association had made similar propositions to the government over the years,
such as incentives for civil servants who did not take sick days. He agreed
that incentives would be needed to convince civil servants to change. “Why
would you give up what you have?” he asked, but he said civil servants were not
being obstructionist and would be willing to “step up to the plate” to discuss
Health Minister Mark Scotland said
unlimited benefit plans for government employees, free of cost, is
unsustainable, especially with the growing costs of premiums, an ageing population
of civil servants and an undertaking to cover indigent people and the
under-insured in a country with no tax and a decreasing revenue base.
He said some steps had been taken
over the past year to enforce insurance requirements that stipulate that all employees
must have health insurance.
Changes to health insurance
regulations also address people who are under-insured but who have the Standard
Health Insurance Contract One, or SHIC One, which is the minimum contract of prescribed
health care benefits.