At the hospital: No shortage of medical sponges

Noting the difficulties her agency has faced as some $70 million in unpaid bills have accrued over the years, Health Services Authority CEO Lizette Yearwood said, “There’s still a culture in the public that a number of persons feel that healthcare is free.”

Well … Isn’t it, though?

Over the past two years, non-paying patients will have racked up $24 million in debts owed to the Cayman Islands public hospital system, which approximates to 12 percent of the HSA’s total revenue of $201 million during that period — or, looking at it another way, 40 percent of the $58 million in revenue the HSA derives from third parties; i.e., not Cabinet or other government entities.

Obviously, for many people in Cayman, healthcare is free. (At least, it’s free for them. It’s the rest of us who end up paying for it.)

Developing over decades, our country’s culture of medical deadbeat-ism is now embedded in all levels of the system, from the tourists who skip off on the next cruise ship out of town, to born-and-bred Caymanians who feel it’s their right not to pay — all the way to the top of Cayman’s healthcare organizations.

Indeed, “intentional nonpayment” seems to extend to the Cayman Islands National Insurance Company, which has been sued several times in the past year by several U.S. hospitals for failing to pay bills for overseas treatments.

At this point, the question of “Why aren’t people paying their hospital bills?” has progressed to “Why should any single person pay his hospital bill, if nobody else is, either?”
Judging by the statements of Ms. Yearwood and former Health Minister Osbourne Bodden, things aren’t boding well for the HSA and its attempts to dig itself free from the rapidly accumulating heap of unpaid receivables. In front of the government’s Public Accounts Committee last week, HSA CEO Yearwood said her agency is being “more consistent in enforcing our payment policy,” particularly in regard to elective surgeries.

Ms. Yearword’s assertion is, of course, astounding — not because of any change in the consistency of policy enforcement, but because apparently the HSA has allowed itself to be stiffed on tabs even for “elective” procedures that, as opposed to “emergency” procedures, are typically scheduled well in advance (and may not even be medically necessary), and accordingly should allow for smooth negotiations with patients over payments.

Last year, former Health Minister Bodden said that some $10 million in payments owed to the HSA over the past several years consisted of individual bills of less than $1,000 each. “If these patients would even pay these small bills, it would make a substantial contribution [toward resolving the debt],” he said — sounding more like a host of Cayman’s annual NCVO telethon pleading for charitable donations than a government official striking a no-nonsense stance on collecting money that is due.

Whenever a creditor resorts to appealing to his debtors’ inner sense of justice, the outcome of the struggle has already been determined.

In the words of economist John Maynard Keynes, “If you owe your bank a hundred pounds, you have a problem. But if you owe a million, it has.”

The HSA’s $70 million in unpaid debts has outgrown the domain of individual responsibility and — along with the hundreds of millions of dollars in government’s various other unfunded liabilities — has become a collective problem that must be addressed by the country as a whole.


  1. A further breakdown of the debtors to the HSA would be helpful to understanding the problem and developing reasonable & perhaps effective solution.

  2. I’m sure there is a degree of intentional non-payment, but how many people on here have been to the hospital with private medical insurance, seen them go through the process of confirming coverage, paid a deductible and then received an additional bill 6 months later from the hospital for charges that weren’t paid by the insurance? My initial thoughts are always, someone messed up the claim to the insurance company and I’m expected to pick up the slack, and not, that’s a legitimate charge owed by me! It gets paid by me eventually, but grudgingly as you have to go through the hassle of finding out what it was for, even then it’s little more than you knew – that the insurance didn’t pay it all, or the hospital didn’t claim correctly.

  3. This would/could have been a non-issue, if they had adopted a universal single payer system. All residents would be covered and for a small fee, depending on length of stay, for vacationers would have addressed this issue. The number of uninsured Caymanians is way underestimated.

  4. Give an interested person(s) 10%commissions on collected debt and see what happens. Get everybody else out of his/her way.

  5. Every time I have been to the hospital I was asked to pay before I left. Sometimes, with things like X-rays, before the service was even provided.

    How then can bills like this be run up?

  6. L.Bell, below: Hey, I’m in!

    Since this method has never been tried (at least to the best of my knowledge), we must presume that the HSA doesn’t genuinely want the debts to be collected. Why, God only knows.