Cayman patients could be referred to Health City

Cayman Islands patients needing heart surgery could soon be referred to Health City instead of overseas facilities, officials have confirmed. 

Around 400 patients were sent overseas with heart complaints in 2008, the most recent year for which precise figures were available. Just under $12 million was spent overseas in that year on the type of cardiothoracic surgeries that will be on offer at the new medical tourism facility in the east end, according to the Health Services Authority. 

The new hospital will have to satisfy the Health Services Authority’s chief medical officer that it meets certain standards before patients can be referred. 

But Dr. Delroy Jefferson, medical director at the Authority, said it had a duty to secure the most appropriate care for patients at the best value for money. 

He said, “Once Health City offers the needed service using established standard evidence-based guidelines offered by qualified competent staff, then there is no need to send the patients overseas.” 

Jeanette Verhoeven, of insurance brokers Aon Risk Solutions, said the ripple effect of Health City’s opening last month may have repercussions for healthcare premiums across the island.  

She said there was potential to save millions of dollars annually – to both insurers and the patients themselves – if patients receive major care at a more cost-effective on-island facility rather than overseas. 

“Everybody is hopeful that this will provide quality, lower the family’s and patient’s distress of travelling whilst ill, and lower costs of care. If he (Dr. Devi Shetty) can justify his ‘Henry Ford of medicine’ tag and be able to offer these surgeries at 30 or 40 percent lower costs than in Florida, it could make a big difference,” Ms. Verhoeven said.  

If the hospital achieves Joint Commission International accreditation, which it is seeking, Ms. Verhoeven believes that could be enough to give private insurers and the local attending physicians a crucial level of comfort to refer patients. 

Both Ms. Verhoeven and Mervyn Conolly, of the Health Insurance Commission, suggested there would still be an element of patient choice, particularly with some insurance plans. 

Mr. Conolly said, “Healthcare is a personal matter, and a patient will likely have involvement on the selection of their healthcare provider, especially if the cost of the medical care will be paid directly by the patient or via their insurer.” 

Mr. Conolly acknowledged that a clause in the Standard Health Insurance Contract – the basic coverage plan which all insurers must provide – stated that patients should be referred to overseas medical facilities only when “treatment cannot be provided at a healthcare facility in the islands.” 

And he said the commission supported the use of local providers, “where necessary and appropriate.” 

“If the SHIC coverage or the provision of the medical care is funded by government, I am of the opinion that the Chief Medical Officer will make a decision on what healthcare provider is available, suitable and affordable to provide the required medical treatment, based on the patients’ diagnosis and medical condition,” he added. 

Ms. Verhoeven believes the language of the standard health insurance contract may mandate that patients on certain plans are sent to Health City rather than overseas. 

“The policy language and benefits on some of the ‘lower’ plans mandate that overseas care is only covered when not available in Cayman or when two MDs or the Chief Medical Officer of the hospital refers the overseas care.  

“Thus, to be covered, the patient is often already obliged to remain in Cayman in many instances which will only be expected to increase as available services expand via Health City and our other medical providers. The logical effect would be less air ambulance transfers, especially for cardiac events, which often do necessitate many of our air ambulance transfers now,” she said. 

Dr. Jefferson added that the Health Services Authority has a “responsibility to secure for its patient the most appropriate care be it local or overseas. The care, if available locally is strongly encouraged.” 

No one from Health City responded to requests for comment. CINICO, Cayman’s public sector insurer, recently signed a new deal with St. Luke’s Heart Institute in Missouri to send patients to that facility. But the deal runs only to February next year, meaning the options to refer patients locally would increase after that point – assuming that Health City is fully operational and accredited at that time. 

Lonny Tibbetts, CEO of CINICO, did not respond to calls or emails from the Compass last week.