The Cayman Islands has 345 outstanding “loans” to residents who do not maintain healthcare coverage, with unpaid balances of $12.3 million owed to government.

The government’s overall cost of providing healthcare to its currently insured employees, retired civil servants, seamen and veterans has increased from $87 million in 2012 to $107 million this year.

The 20-year estimated liability government carries for future healthcare expenses, measured at today’s value, has ballooned from $654 million in 2004 to $1.18 billion in 2014. “Essential services such as education, national security and healthcare are underfunded because of the healthcare costs and the long-term healthcare liability,” Finance Minister Marco Archer said Friday.

Minister Archer told the Legislative Assembly in a statement that the government “recognized the gravity and significance of the healthcare cost liability facing the country and the struggles it presented in preparing the budget annually.”

The minister, who faces a re-election by May of next year, said those reasons – as well as some others – explain why government has come to the decision that civil servants will have to start paying a portion of their own healthcare premiums by 2018.

The problem is so daunting that charging civil servants for a portion of their monthly healthcare costs won’t, by itself, fix the issue, the minister said.

Other measures being considered are expected to be implemented shortly.

Those include a proposal – expected to come before the Legislative Assembly next month – to raise the civil service retirement age to 65. Increasing the current retirement age from 60 would mean government workers pay into the healthcare system longer, putting additional funds toward future liabilities in healthcare.

“The proposed increase in the retirement age will benefit civil servants in numerous ways, such as allowing willing and able civil servants to earn a higher salary [rather than] a pension, or being able to negotiate lower mortgage payments with more years to repay their mortgages,” Mr. Archer said.

Other options being considered that won’t appear before the assembly in the next meeting include a proposed cap on lifetime health insurance benefits per employee. That cap now stands at $5 million. Mr. Archer said even upper-echelon private sector health plans max out at $2 million lifetime benefits.

The government is also weighing graduated benefits for retirees; in other words, whether someone who has worked in the civil service for 10 years should receive the same level of healthcare coverage in retirement as someone who has had a 30-year career in government.

The cost of healthcare benefits is an issue the U.K. has raised with Cayman in previous budget meetings. Mr. Archer said former Overseas Territories Minister Mark Simmonds addressed the issue in June 2013, right after the Progressives-led government took office.

“The minister stressed his concern about the size of the civil service and the related cost and liabilities and queried what the government intended to do about it,” Mr. Archer said.

Mr. Archer said the government has discussed lowering healthcare costs with civil servants and government managers several times, and added that he stood by statements made last month that indicated it was “pretty much accepted” civil servants would have to pay a portion of their own healthcare costs.

“It is pretty much accepted that the implementation of co-pay should come with choice of healthcare services provider,” he said. “What remains to be agreed are the details of who will contribute and how much the contribution will be.”

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  1. I support Civil Servants paying a portion of their health care, but the HSA need to offer much more to put such a plan into action.
    Take for instance, why should anyone want to contribute towards a plan that no matter how seriously sick you are, you are only given Panadol, by mouth or drip, Balmosa and more Panadol.
    People are being diagnosed each day with terminal diseases and when stock is taken they have been attending the hospital, General practice for years and given nothing accept Pain killers. No one thinks let us do a thorough investigation on a patient.
    Many patients are terminally ill because doctors are not taking the time to really find out what is causing a patient illness before prescribing pain killers and back rub, and medication of the cheapest sort.
    How can we now want to pay a portion if we are not getting good service. It is not fair. Contributing is one thing, but contributing to professional care is another. Many patients are not aware of it, but my suggestion is to carefully monitor what is given to you, when you either attend HSA for emergency or out patient care, you might as well drink the Kool-Aid before you go.

  2. “Why? Your insurance will cover it.” – Dentist upon hearing that a patient would seek a second opinion regarding the need for recommended oral surgery.
    Wildly overinflated hospitals costs.
    A Tylenol pill for $15? Or $53 per pair of gloves? Patient belongings bag $8; box of tissues $8; plastic cup medicine- $10, for a total of $440 during average patient stay; marking pen-to mark a patient for surgery $17.5; Use of blood pressure cuff $20; charge for nurse to hand you medicine taken by mouth $6.25 per instance, for a total of $87.50 during average patient stay; Cost of use of overhead light in operating room $93.50; Swabs, alcohol – $23 per swab, for a total of $322 during average patient stay.
    The foundation of current health care system is the treatment (mostly symptoms management) of illness and disease rather than the promotion of good health. If conditions created to make it possible for people to take better care of themselves, countless medical conditions such as type II diabetes, certain cancers, heart disease, and obesity could be prevented. Diabetes and hypertension can often be prevented by modest changes in daily behavior.

  3. Further to my comments, do we the public really know how many men and women in the Cayman islands are on the cancer patient list just because they have been treated with Balmosa rub, and Panadol and ibuprofen for more than ten years. Diagnosed that they have Gallbladder, when they have stomach cancer. Diagnosed that they have ear infection, when they have brain tumor. Diagnosed they have bladder infection, when they have prostrate or colon cancer!! Just because cheapness would not allow proper test to be requested. Men are sick and dying with prostrate, stomach and colon cancer because no proper investigation was requested. Yes, I am saying no proper investigation requested. How can anyone be so CHEAP and HEARTLESS not to want to save a persons life by just having these BLOOD TEST done, by having MRI, ULTRA SOUIND and CT Scan.
    Women discovered to have breast Cancer, ovarian cancer, colon cancer and cancer of the womb and others. While we do what?…… BE CHEAP and HEARTLESS to even consider sending them to have a mammogram, ultra sound or blood test for ovarian cancer. Yes, all it takes is a blood test and some scans. These people have CINICO, and if you have CINICO, watch out what happens to you at HSA. Oh no!! That is too expensive to save your life by doing a CT SCAN or an MRI. Not unless you have Big time Company Insurance or paying cash up front. Observe how paying patients are treated. NOTE that you cannot even get an appointment within six months if you have CINICO. Further, this treatment is seen across the board.
    District Clinics? Should all be investigated. You can go for a headache and watch out carefully that your medication prescribed does not say for urine infection.
    We have a good Hospital in Building, but it ends there.
    Should someone be blamed for all of this? Yes, of course, and unless we get the right persons who care about people and not just Government Pay Day; people will be diagnosed and slowly dying on this island daily just for a simple Blood test or Scan to save their lives. Stop being cheap and playing with people’s lives.