Auditor General Sue Winspear, who succeeded former Auditor General Alastair Swarbrick in July 2016, has picked up right where her predecessor left off — providing evidence that the Cayman Islands government is simply incapable of running large enterprises.
One of the largest of those governmental responsibilities is oversight of the country’s healthcare system. In 2015, total health-related expenditures in Cayman amounted to around $269 million, with the costs split about equally between the public and private sectors. (We’re talking real money here, folks, with private sector spending increasing by 37 percent since the government’s 2010/11 fiscal year. And don’t forget that the ultimate source of all “public spending” is, of course, private pocketbooks.)
Despite the rising flood of expenses, the government’s management of Cayman’s healthcare system is, in a word, in “shambles.”
To use Ms. Winspear’s words, “The government does not have the resources or the information required to manage the health system effectively, and neither the Legislative Assembly nor the public can be confident that high quality healthcare is being delivered, or value for money being achieved.”
The report delves into gaping abysses in government’s collection of information on healthcare outcomes, despite (or perhaps because of) the existence of some 30 laws regulating public and private healthcare services.
One reason given for this is the complex nature of Cayman’s “hybrid” healthcare system, with public and private entities often intertwining in the delivery of and remuneration for services.
Another difficulty is the fact that, demographically, Cayman is bifurcated between a relatively healthier (and far more transient) expatriate population, and a relatively less healthy Caymanian or “local” population. “[Current] health statistics … risk distorting the apparent performance of the health system,” according to the report.
In terms of regulation, standards for health practitioners can vary according to individual circumstances, “required” inspections of facilities are not always carried out, actual compliance with existing laws is unknown, and sometimes the laws themselves have been deemed to be inadequate. For example, the law governing Cayman’s pharmacies is nearly 40 years old.
Though it won’t make anyone healthier, it may make our readers feel better to know that our behemoth neighbor to the north, the United States, has its own tremendous share of healthcare problems. New President Donald Trump and the majority Republican Congress have made “repealing and replacing” the Affordable Care Act, otherwise known as “Obamacare,” a top priority. (The catch is that, while the “repeal” part of their plan is fairly clear, what precisely they propose to “replace” Obamacare with remains, ahem, unclear.)
The above, combined with the continual stream of news headlines depicting the difficulties, dysfunctions and outright failures surrounding so many areas of activity by Cayman’s government, including education, pensions, cruise berthing, turtle farming, the dump … even parking at the airport, points to a simple observation that underpinned the erstwhile “EY Report”: Our government should be involved in doing far less, at far less cost to taxpayers, and with far less opportunity for mistakes, misappropriation and malfeasance.
Not only is Cayman’s government unable to execute projects and programs of significant size and scope, it can’t even abide by basic and fundamental accounting principles — such as producing accurate and verifiable financial statements. As we report on page 1 of today’s Compass, the auditor general’s office has given an “adverse” opinion on government’s entire public sector finances for 2014/15 (meaning government flunked the accounting test, once again).
With more than 6,300 public servants in Cayman (more than 15 percent of the total labor force) and a public sector budget approaching $900 million per year, our country’s governmental services should be impeccable. But far too often, we find that taxpayers are paying far too much, and receiving far too little in return – that is, when we even know what we’re getting.