Health services face $70m in ‘bad debts’ from unpaid bills

HSA cayman islands

The Cayman Islands Health Services Authority expects to have nearly $70 million in unpaid bills from services it rendered to patients by the end of the upcoming budget year in June 2015, according to government financial records.  

The amount is referred in the government’s 2014/15 budget ownership agreements as a “provision for doubtful debt,” meaning debts that have been owed for more than a year. If the projection of the additional unpaid bills occurs as finance managers expect, the Health Services Authority will have gone from having an estimated $45.8 million in these unpaid receivables to $69.9 million in just two years.  

The total allowance for unpaid receivables has been compiled over a period of more than 10 years and some of the bills owed are more than decade old.  

Public health officials told lawmakers Thursday during Legislative Assembly’s Finance Committee proceedings that the hospital system, like most public health facilities around the world, could not hope to recover every dollar it spends on operating costs, although they do make significant effort to recover monies where possible.  

“There are ongoing efforts by the [Health Services Authority] to collect each year,” Health Minister Osbourne Bodden said. Over the past two years, none of the unpaid bills have been “written off” and Opposition Leader McKeeva Bush said that would probably have to be done, given the age of some of the unpaid amounts.  

“I do believe we need to look at [this issue],” Mr. Bush said. “Various persons just cannot pay for healthcare.”  

George Town MLA Roy McTaggart, an accountant, agreed with Mr. Bush. “We’re carrying years and years of bad receivables,” he said.  

Cayman Islands Finance Minister Marco Archer said that his ministry is looking into the overall problem of unpaid, past due debts for government services and would soon be reporting that information to Cabinet.  

The government’s financial statements for the 2014/15 year indicate that all statutory authorities and government-owned companies are owed a balance of $15.9 million in “trade receivables” – payments for services – that are more than a year old.  

With regard to the Legislative Assembly debate on the Health Services Authority’s unpaid debts, Mr. Archer said the payments would have to be considered on a case-by-case basis.  

“While there is a legitimate case of some people being unable to pay, there are some people who believe they do not have to pay,” he said. 

North Side MLA Ezzard Miller said government discussed as part of its 2014/15 budget plan some $19 million to cover local healthcare costs for those without health insurance and another $11 million for tertiary local and overseas healthcare costs for indigents, seamen and veterans. However, Mr. Bodden said those were costs agreed to be paid by government in the upcoming budget.  

The unpaid bills provided for in the Health Services Authority budget for the current fiscal year were $15.3 million. In the upcoming year, those are expected to total up to $14 million more.  

“We’re talking about $30 million,” Mr. Miller said. “How can we have $14 million in bad debts for the year?”  

Minister Bodden, who did not necessarily agree with the use of the term “bad debt” in relation to the receivables, said the government would seek to defray some of the overseas healthcare expenses by using the Health City Cayman Islands facility now in operation in the Frank Sound area.  

“If it makes [financial] sense, the better option will be used,” Mr. Bodden said. “I can only imagine in the end that local care is cheaper.”  

HSA cayman islands hospital

Cayman’s main public hospital is missing out on millions each year in unpaid bills.


  1. This bill will continue to be a problem in Cayman. First problem is the law says you have to pay insurance. Second problem is the insurance doesn’t have to pay the bill. If you have a preexisting problem the ins. won’t pay. What kind of law is this? Insurance is suppose to support sick people. First thing they do is charge sick people more money??? Then they make you sign a waiver release form not to pay for certain illness that you will PROBABLY get? The law should force insurance companies to pay for any clients they have on their books. They are collecting money by law. Why should anyone pay twice? It is an unfair law and it hurts the old and low paid workers. Again minimum wage could help solve this problem too.
    This should be a human rights issue. The UK gov’t pays for medical, dental and eye care. Why can’t Cayman do the same? Cuba, a communist country, can. It is ridiculous that the insurance country does not offer everyone dental and eye care.
    If by chance you’re not their customer and you have a sizable claim, say a car accident, God help you. You will have to go to court if you can find or afford a lawyer, then they will make the court case go for ever. Hoping that you will run out of money or die.
    There have been people who have taken the insurance company to court, remember Hyatt? There have been people in Cayman that have been in car accidents that have lost their ability to walk or work. They are offered some small pittance of a claim hoping they will run out of money. Therefore lose their lawyer to represent them. Where is the law that these cases be handled in a reasonable amount of time? Where is the law that will allow all people to be charged the same amount of premium? Where is the law that guarantees representation without conflict of interest? Unfair, unfair and unfair.

  2. Maybe they just don’t know how to collect? Hard to believe when pretty much everyone carries an insurance. No one lifts a finger until your insurance is verified. Don’t say that those who are not insured are so ill to generate so much debt.

  3. The big problem with insurance and something people don’t seem to understand is that they are running a business and are in it for the money not to help people. This is why they basically attempt to deny every claim. They like getting paid not paying out.

  4. Lucia, the fact is that people get treated who don’t have insurance and then they skip before anyone finds out. I can remember a few years ago an ex-pat being taken seriously ill on Grand Cayman, they received emergency treatment that allegedly cost well over CI100K but had no insurance to cover it so dealt with that problem by just getting on the next flight home after being discharged from hospital. Nobody at HSA checked anything.

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