HSA will sue to recover debts

The Cayman Islands public hospital system will begin suing patients or businesses that owe healthcare debts, the agency’s chief executive told lawmakers Wednesday.

The Health Services Authority, the entity that runs the Cayman Islands Hospital and associated health clinic operations, reported in June that its provision for “doubtful debts” for health services (those more than a year old) stood at $90 million.

The figure represents the amount of patient fees the authority estimates it has not collected for one reason or another for at least 366 days. Some of the debts date back more than a decade, HSA Chief Executive Officer Lizzette Yearwood said Wednesday, and have little chance of being recovered.

However, Ms. Yearwood said, for some of the more recent uncollected debts, the authority intends to enlist the help of local law firms – via a request for proposal process – to assist the hospital system in rounding up delinquent payers.

“Going forward, all debt that is owed to the Health Services Authority will be pursued to the full extent of the law,” she told the Legislative Assembly’s Public Accounts Committee, adding that requests for proposals are due out Friday to invite local firms to assist the HSA in collecting the debts.

The public hospital system has long taken the position, formally doing so in 2010, that it would not sue local residents to collect on past due healthcare payments. In some cases, liens have been placed on local properties to recover the amounts, but no lawsuits have been filed.

Ms. Yearwood clarified that most of the current bad debt figure is likely to be unrecoverable, but that her staff estimates some $10 million could be “reasonably” recovered.

A large portion of the unpaid debts have been accumulated by public hospital system patients who haven’t made good on payments for services or pharmaceuticals. However, Ms. Yearwood noted, some of the amounts were also due from private insurance companies that had not reimbursed the HSA for services.

Those private insurance fees represent about 2 percent – roughly $2 million – of the doubtful debts figure.

PAC questions

Public Accounts Committee Chairman Ezzard Miller asked Ms. Yearwood why, if most of the debts were thought to be unrecoverable, the HSA had not simply “written off” the amounts in previous budgets.

Ms. Yearwood said she had no power to do so and that the matter was “in discussion” between HSA board members and the Health Ministry.

Mr. Miller wondered why individuals determined to be “indigent” and unable to pay healthcare bills weren’t receiving assistance via local welfare agencies.

Ms. Yearwood said in those cases, individuals who have experienced delays in seeing the government’s Needs Assessment Unit are funded via indigent care amounts provided in the budget.

“However, that is still a very small sum of money in the large scheme of things,” she said.

There are also other situations that arise in which the public hospital must cover uninsured individuals, Ms. Yearwood said.

“We have persons who are visitors to the islands … as a public hospital, we are required to take care of a person in an emergency if they so need those services,” she said. “There are some conflicting requirements. We want to collect for all the services we provide, but at the same time, we are a public hospital.”

Auditor General Sue Winspear said figures compiled by her office indicate that the HSA amassed $120 million in uncollected debts since it began operations as a public authority in 2001. A portion of that has since been “written off” as uncollectible.

During the same period, the Cayman Islands government has provided $130 million in “equity injections” to support public hospital operations, Ms. Winspear said.


  1. We all should support and work with Ms Yearwood on this move, because if these large amount of bills are not paid how can the hospital continue to get new equipment and first class medications that are not synthetic.
    Another thought would be that some of these bills that are owed by persons who were on work permit, their bills should be be attached to their file at immigration department. Many person who have gained Cayman Residence and status failed to pay also and persons left the island for a period and come back and nothing done. This should show up on a persons file when re entering the island. Caymanians and everyone else who are able, and has a job or business should be forced to pay their medical bills.

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