This year saw the launch of a five-year national health policy and strategic plan for the Cayman Islands which aims to address how to provide affordable, sustainable healthcare while addressing the rising prevalence of diseases like diabetes and hypertension.
Health Minister Mark Scotland in February delivered the document that outlines how the government may navigate through the rising costs of healthcare amid increases in non-communicable diseases, admitting this “will be an ever present and infinite challenge”.
The only way to make progress, and to measure it, in healthcare is to set clear objectives for healthcare, said the minister, adding that the over-arching strategic plan did just that.
“For government agencies, this means they can now move for strategy to implementation, efficiently and purposefully; and for our private sector health partners, it means they can align their efforts with national health objectives,” he said.
By aligning objectives with strategies, Mr. Scotland said he hoped the strategic plan would also help change people’s perception of their health. “We must squarely face the enormous problems of obesity and the financial and personal toll of non-communicable diseases,” he said.
Hypertension, also known as high blood pressure, which can lead to strokes and heart attacks, is the most prevalent disease in Cayman, with the HSA treating 3,273 patients with the condition in 2010, compared to 2,581 in 2006.
Diabetes is the second most common health problem, with 1,691 patients in 2010, and mental health issues the third most prevalent.
Tackling the rising costs of healthcare, whether in the private or public sector, and finding innovative solutions has been a challenge to governments worldwide and Cayman is no exception.
Almost one-fifth of the Cayman Islands government’s entire budget goes towards healthcare costs. Of that amount, 22 per cent, or about $20 million per annum, is spent on indigent care locally or overseas, meaning the government picks up the tab for those who cannot afford enough or any insurance to cover their medical costs.
Earlier this year, a change in the insurance law increased the premiums and benefits of the Standard Health Insurance Contract, known as SHIC 1, which is the basic minimum coverage plan that all policies must include and which covers about a third of Cayman’s residents. This had the knock-on effect of upping the premiums for other coverage plans.
With more benefits covered by the basic plan, this means that government will not have to step in so often and cover the healthcare costs of people who are underinsured.
Candidates in the upcoming election are cognizant of the fact that healthcare will be one of the major issues they will have to address if they come to power.
During the recent Chamber of Commerce district candidates forums, several nominated candidates addressed the issue of healthcare. In George Town, for example, candidates agreed that the cost of healthcare and the current lack of certain medical services were issues for concern.
Coalition for Cayman-endorsed independent candidate Winston Connolly pointed out that Cayman’s existing insurance policies effectively screened out people with pre-existing conditions in many case and that the SHIC plan did not provide for the cost of specialists. He advised that Cayman’s small population of some 55,000 could band together to secure coverage rather than small pockets of individuals getting coverage on their own.
Former Leader of Government Business Kurt Tibbetts also acknowledged that the cost of healthcare in Cayman is an ongoing and major issue and he hopes that the new Health City Cayman Islands, currently being built in East End, will provide more medical professionals for the Cayman Islands and reduce the amount of overseas travel for medical procedures.
The need to travel overseas for healthcare has been a drain on both the government and private individuals’ purses for many years. For the year ending, June 2011, the cost of overseas healthcare claims incurred under CINICO’s insurance programmes for treatment off-island for civil servants, veterans and seamen, indigents and other residents covered by the government’s insurance company was almost $30 million.
Independent candidate Bo Miller agrees that the cost of healthcare, including the premiums demanded by insurance companies, in Cayman is a major issue. He agrees that pooling the entire population together to seek health coverage on the private market is the way to go. Mr. Miller said he was already discussing a solution with a worldwide company that offers healthcare coverage designed for people who reside outside the US but who sometimes have to receive healthcare in the US.
People’s Progressive Movement candidate Kenneth Bryan also identified the long-term costs of healthcare as a major issue for the Cayman Islands, one that could be offset by early intervention. He advocates for better education for the Islands’ young population on healthy living and healthy eating in schools.
Another independent, Sharon Roulstone, pointed out that one major ongoing cost in healthcare in Cayman is the lack of a cardiac unit with a specialist on staff locally, meaning that currently cardiac patients are usually flown off island for care. A lack of dedicated mental health facilities in Cayman also place a big burden on the government’s finances as often it is the government that ends up paying for patients with mental health issues being treated in overseas facilities. Currently, the Cayman Islands Hospital has a “safe facility” – an eight-bed, short-term in-patient mental health ward – but no local long-term care option for chronic patients, most of whom are placed at facilities off-island. Mental health patients have also been housed in the local prisons which can be designated as places of safety for patients.
People’s National Alliance candidate and incumbent deputy premier Rolston Anglin, running in West Bay, responding to a question on how Cayman can cut back on how much it spends on healthcare, said this could be done by partnering with more centres of excellence overseas, similar to CINICO’s existing arrangement to send heart patients from Cayman to St. Luke’s Mid America Heart Institute in Kansas City and for specialists from that institute to come to Cayman to care for patients here. He also agreed that the Shetty hospital would hopefully bring enhanced tertiary care to Cayman. “In the medium term, we have a real opportunity now to bring cost healthcare costs down if we do those things,” he said.
C4C-endorsed West Bay independent candidate Mervin Smith said that he was glad to see that Cayman was moving away for teaming exclusively with hospitals in Florida, which he described as one of the most expensive areas for healthcare. He wants to see health plans that are more comprehensive. “We know of far too many incidents where individuals working here who don’t have the coverage they need and once they get hurt… the cost is borne by the country. This is one area where we can have an impact if we put the proper legislation in place and ensure it is adhered to, we’ll see a reduction in healthcare costs.” Legislation was also on the mind of United Democratic Democratic Party’s Bernie Bush in West Bay who wants to see stronger legislation to prevent insurance companies from denying insurance coverage to older, retired people, whose medical costs end up being covered by government through CINICO.