If the Cayman Islands healthcare system were a patient, its medical case file would be a meter thick, containing a myriad of specialists’ assessments in regard to various disorders, illnesses and syndromes, payments to care providers, insurance rates, and government-mandated health insurance payroll deductions from all employers and employees.

On top of all of that, more than $50 million in uncollected (uncollectible?) fees are currently owed to the Health Services Authority for hospital services rendered, many of them years ago.

Last Friday’s Compass story about Cabinet’s decision not to increase minimum fees that health insurance companies pay to healthcare providers for services rendered is just the latest example of dysfunction in the system.

Called “standard health insurance fees,” the schedule is basically a detailed “menu” of medical procedures and their cost to health insurance companies — ranging from “health risk assessment test ($17.61)” to “biopsy of eyelid ($250.20)” to “cranioplasty for skull defect with reparative brain surgery ($4,948.20),” and everything in between.

The list of fees was created in 2005 and has not been updated since, truly a stunning statement given the advancements in healthcare service and medical technology over the past 11 years. That decade-plus also included the evolution of the local healthcare landscape, spurred in no small part by the introduction of Health City Cayman Islands. Setting aside trends specific to the medical sector, can you imagine running a business in any industry where fees for services have been set in stone for more than a decade?

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Enter the Ministry of Health, which commissioned a consultants’ report on healthcare costs that was completed last year. Ultimately, the Canada-based company Morneau Shepell recommended increasing the standard insurance fees paid to healthcare providers significantly — by 12.3 percent.

Last Thursday, Cabinet announced that it was giving a thumbs-down to Morneau Shepell’s recommendation, effectively tossing the document in the ash-heap of historical consultants’ reports for government.

This particular case, however, has a twist. As we wrote in Friday’s story, “The consultants asked 139 physicians and 67 health practices to voluntarily provide financial information so Morneau Shepell could study how much medical procedures cost in Cayman. Only 40 responded, according to the consultants, and fewer than 10 provided the financial information.”

Cabinet concluded the consultants did not have sufficient information on which to base their recommendation and decided to make no move on fees for now, until the government gets greater cooperation from doctors.

It seems easy to blame the doctors for not divulging their financial information to the consultants. After all, they would be the apparent beneficiaries of any increase in the standard health insurance fees. (The consequence to patients is not as clear because an increase in insurance company payments almost certainly would lead to an increase in health insurance premiums. This, in turn, would lead to greater payroll contributions from both employers and employees.)

However, from where we sit, the low-participation rate from the physicians appears to be linked to the design of the study itself, which relied on health providers to disclose — voluntarily — sensitive financial information both to government and to a group of unknown overseas consultants. Providing business information, when your competitors do not, can put a company at a decided disadvantage. The government’s assurance that the information will be kept confidential is less than reassuring.

And so the obvious occurred: The consultants asked politely, and the healthcare providers declined politely.

If anything, this story puts in the spotlight a prevailing problem in Cayman’s healthcare system – the lack of transparency in pricing. Nobody seems to know how much anything costs, not the patient who is electing to undergo the procedure, not the health insurance companies which pick up much of the tab, and certainly not the government which is supposed to be regulating the entire operation.

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