The Cayman Islands government is considering a formal contractual agreement made between its insurance company, its public hospital system and Health City Cayman Islands for the referral of government hospital patients.
Correspondence obtained by the Cayman Compass has revealed the proposal appears to be in bureaucratic limbo over what government ministers have perceived as the reticence of the Cayman Islands National Insurance Company, known as CINICO, towards such an arrangement.
CINICO officials denied such reluctance and confirmed last month that about 200 CINICO-insured patients have already been referred to Health City Cayman Islands since the facility opened in February.
However, according to an email sent to Finance Minister Marco Archer in late August, which was obtained by the Compass, CINICO officials did note a number of “challenges” regarding client referrals to Health City.
“A number of these referral requests are for services that are already provided locally via existing providers,” according to an email sent by CINICO chief executive Lonny Tibbetts, on behalf of the insurance company’s Risk and Appeals Committee, to Minister Archer on Aug. 29.
“As you may recall, one of the pledges of [Health City] was to not interfere with the existing services provided by local physicians/facilities, including the Cayman Islands Health Services Authority,” Mr. Tibbetts wrote. “As such, we all share the common understanding that [Health City] would be used exclusively for tertiary services and/or secondary specialty services not previously provided locally.”
Those services included pulmonary treatments, pediatric endocrinology and orthopedics, among others, the email noted.
Health City Cayman Islands local partner Gene Thompson said in an interview Wednesday that the hospital was in discussions with government about patient referrals and was essentially trying to head off potential situations where Health City was forced to turn away local patients who wanted to use its services. However, Mr. Thompson said the Health City Cayman Islands business model was not based on providing local healthcare services.
“Our hospital is designed and built to bring in international medical tourists from the Caribbean and other overseas jurisdictions,” Mr. Thompson said. “In the meantime, if we can assist in providing high quality healthcare at a lower cost to the Caymanian people … it’s our honor to do it and we are contractually obligated to do it.”
While no formal contract for patient referrals between Health City and CINICO/Health Services Authority exists, Mr. Thompson said the hospital is obligated to provide a 20 percent discount to HSA and CINICO patients who are referred there. Mr. Thompson estimates that close to 400 CINICO and Health Services Authority patients have come through the doors so far. In all, the East End hospital facility has treated about 1,500 patients since late April, he said.
According to Mr. Tibbetts’s August email to Minister Archer: “The authorization and/or support of a referral to [Health City] for services already available locally presents all of us with a number of dilemmas. This will likely result in displeasing the existing local provider[s] and possibly causing irreversible damage to longtime relationships.
“If we pledge exclusivity, or steer a significant amount of our members to one facility, we risk the financial viability of one or more providers/smaller competitors, who may, in turn, close, thus inadvertently creating a monopoly in the long run or other challenges.”
For instance, Health City Cayman Islands provides both non-invasive and invasive cardiology techniques at its facility in East End. Local healthcare providers do not perform invasive cardiology treatments, but currently non-invasive treatments are shared between the Cayman Heart Health Center and TrinCay. Those two agencies provide doctors to perform those services at the Cayman Islands Hospital in George Town on a rotating basis.
If patients were sent to Health City instead, Mr. Tibbetts argues in the email, TrinCay might not offer such services in the future, forcing the Health Services Authority to shutter its emergency cardiology treatments. Health City doctors would not be allowed to substitute since their doctors are not licensed to practice outside of the Health City Cayman Islands facility.
The email ends with a request for “ministerial assistance” to establish protocols that have been mutually agreed between healthcare providers going forward.
Contacted for comment, Minister Archer said government was attempting to sort out those issues with regard to a contract with Health City and CINICO. Meetings were held twice within the past two weeks on the subject, Mr. Thompson and CINICO administrators confirmed.
Previous discussions in the Legislative Assembly have noted that government was considering using Health City in attempt to reduce some of its bill for tertiary, or overseas, healthcare providers. Those are services currently contracted with St. Luke’s Medical Center.
In the Legislative Assembly’s Finance Committee on June 12, Health Minister Osbourne Bodden said the issue would ultimately come down to cost.
“The better option will be used,” Mr. Bodden said. “As Health City is just getting going, it’s hard for me to say that their [price] is over or under, but I can only imagine in the end that local care is cheaper.”