Thanks to healthcare visionaries from the Cayman Islands, the United States and India, we can boast that our country is home to one of the Caribbean’s premier medical facilities.

Health City Cayman Islands is saving many lives, and improving many more. It is creating new career paths for Caymanians and bringing much-needed diversity to Cayman’s economy. And it’s just getting started.

It took years of courtship, negotiations and deal-making in order to attract Dr. Devi Shetty’s Narayana Health and U.S.-based Ascension to our shores; but now, it seems there are public officials who are doing their utmost to chase them away … in the name of (get this) “competition.”

Now, when anyone in government employs the word “competition” — as Health Services Authority Medical Director Dr. Delroy Jefferson did repeatedly during a recent hearing before lawmakers — we put up our guard. When they utilize it in the phrase “unfair competition,” we head for higher ground.

As we report in a news story in today’s Compass, Dr. Jefferson expressed concerns that Health City appears to be competing with local doctors for patients (against the hospital’s stated purpose as a medical tourism facility for international patients), and has an advantage due to duty concessions that other medical providers do not enjoy.

Since Dr. Jefferson broached the subject, let’s briefly discuss unfair advantages, specifically the ones that apply to HSA:

  • Section 12: The HSA Law contains an “immunity” provision that prevents people from suing HSA or its staff (including physicians and nurses) for wrongdoing except in limited instances where “bad faith” can be demonstrated.
  • Group insurance: The authority has corporate insurance that covers its doctors as a group, giving it superior leverage to individual private doctors.
  • CINICO: The public insurance company funnels its policy holders, including thousands of civil servants, to HSA.
  • Unpaid bills: The authority has failed to collect some $120 million in debts since 2005, in effect drawing a subsidy from the public coffers to the tune of $15 million per year.
  • Public sector HR practices: The authority, like all public entities, operates under a different set of regulations than does the private sector, including work permits, pensions and healthcare benefits.

Need we continue?

Generally speaking, Dr. Jefferson may have a point about unevenness in the competitive landscape of Cayman’s healthcare environment. Here’s our proposal: Level the playing field, open it up to real competition, and see who’s left standing.

We mean exactly that. Any incentives and exemptions granted to Health City should be extended throughout the private medical sector. Health City doctors should be allowed to practice anywhere, and treat anyone, that other doctors can. Section 12 should be excised from the HSA Law. CINICO clients should be able to visit any physician of their choice.

Anyone who knows of Dr. Shetty knows that he has become world-renowned for providing the highest-quality healthcare to patients at the lowest possible cost. That is the model that Health City has adopted and HSA should be studying and emulating.

Specifically in regard to HSA, the government’s goal should be to empower the private sector to such a degree that it effectively puts the Cayman Islands Hospital out of business altogether — not to shore up an institution that is widely perceived to be inefficient, if not ineffective.

When it comes to the delivery of healthcare, the consequences of policies aimed at “protecting” local providers aren’t just damaging to the economy, they are potentially harmful to the health of the population.



  1. I always believe that good will follow a person wherever they go, just as well bad.
    To say this is to say, The Shetty Hospital has gained a reputation for itself whereby only good things are being said. Just the other day a friend of mine took her daughter up there for a gallbladder surgery, and she said that the round a clock care was exceptional. So often that nurses and doctors were constantly doing rounds and checking on the patient.
    Who we employ has a lot to do with our successes whether we believe it or not, and if we have employees in Health care who are not professional, and friendly, no matter what we have we wont get well.
    Having a competition with the Government HSA as understood by “Town Talk” is that it has gained a reputation for itself , whereby people are not trusting the care given. Honestly I must say at the HSA, there are doctors who are exceptionally good, whom I know go beyond the call of duty to see that their customers are given the best care. To name a few Female Dr. Baredo from Cuba, Surgeon Dr. Mathews, Surgeon Dr Bromel, and some new doctors recently came. There are a few others I do not remember the names but the problem is being ” Eye On the Ball” and they have their eye on the ball. Some of the best nurses you will find at the Maternity ward and a few here and there, but this is what is and will cause the competition. So unless we have a CEO at HSA who MAKE SURE THAT EVERY ONE is on their toes nothing will change and there will be competition whether people have money or not.
    We are living in a world where we should be able to choose freely, especially when it comes to HEALTH CARE , and I believe that HSA should not stifle patients who can get PROFESSIONAL CARE by being able to attend the SHETTY or ANY OTHER PRIVATE HOSPITAL using their CINICO CARD. That is communist ruling to prevent this. THAT CINICI CARD SHOULD BE OPENED TO ALL HOSPITALS HERE AND ABROAD, EVEN IF THE PATIENT HAS TO PAY A YEARLY SMALL FEE TO ALLOW THIS OPENING. If I am satisfied with my doctor at the HSA, and know full well I am getting the best care, I am not going to visit another hospital anywhere unless he tells me to. So let us consider this.

  2. The subject of competition in healthcare is an interesting one, and one that is an issue around the world. It is good to see this discussion here as Health City moves forward into the market, expanding and adding services to attract foreigners to our country and as new owners of Tomlinson Hospital are on the horizon.

    HSA should not be afraid of competition if it is truly doing its job in a responsible, professional manner. The fact is many of our residents will always look to HSA for their medical care. The reason is that is where they have always gone, that is where they are comfortable, that is what is convenient, and that is where they have been treated their whole lives.

    As it happens I have had some experiences with both public and privare health care systems in other countries, both as a consumer and as an administrator. As stated by another writer, you really need to look at the director of the health instituation to find out how the facilitiey is run. Where there are caring, responsible administrators there will be caring, responsible staff to directly provide services at all levels. That is to say, if the leader is a good one, you will find good doctors, nurses, ancillary and support workers. This goes for both publically run and privately run facilities.

    If any business or organization finds itself losing “customers” to the competition, it needs to look inward to determine how it can match or exceed that competition. NOT look for ways to surpress it. This is similar to countries like the US, Canada, France and others who are losing citizens to countries like Cayman, Bahamas, Turks and Caicos and others. Instead of looking inward to find out why people are leaving, those governments look at ways to stifle expatriation while they spread lies about countries people choose to immigrate to.

    I would venture to say there are plenty of “customers” for all three hospitals, especially if one or more facilities manages to find a way to attract patients from outside our island. The trick is for consumers (and the government) to demand accountability of all who are entrusted with our health and our very lives.

    So to the leader who is trying to thward competition, I suggest you look in the mirror and find the real reason your hospital is losing patients to the competition.


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