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.