Cayman’s medical health professionals are “overwhelmingly” dissatisfied with the financial aspects of the healthcare system, and told auditors several areas need significant improvement.
The results were reported in a survey of 101 medical professionals in Cayman, about three-quarters of whom are physicians. The auditor general’s office conducted the survey in early 2016 as part of its review of the healthcare operation in the public and private sectors.
“The survey results point to overwhelming dissatisfaction with the financial aspects of the healthcare system including affordability, insurance reimbursement and payment collections methods,” the survey noted.
Out of 82 respondents, more than half said affordability of the healthcare services in Cayman was either “fair” or “needing improvement.” Only about 20 percent of those responders said affordability was excellent or very good.
Of 81 respondents, half said insurance reimbursement processes needed improvement. Doctors, in particular, argued that the current standard health insurance fees – paid to doctors via insurers – were inadequate to cover costs and had not been increased in more than a decade.
Out of a total 83 respondents, about half said the collection of payments for health services needed improvement. No one taking the survey rated payment collections as “excellent” in the Cayman market.
Uncollected revenues for healthcare services is a daunting problem for the government-run Health Services Authority, which had amassed “bad debts” of $95 million as of June 2016, according to auditors.
The bad debts are hospital bills that have remained uncollected for more than one year and are considered unlikely to be collected. The HSA acknowledges that many of the debts are more than five years old.
The health authority has hired a debt collection firm and has pledged to begin suing patients who fail to pay, something the hospital system has not done since at least 2010.
Health Services Authority Chief Executive Lizzette Yearwood said last fall that most of the current bad debt figure is likely to be unrecoverable, but that her staff estimates some $10 million of the $95 million could be “reasonably” recovered.
A large portion of the unpaid debts have been accumulated by public hospital system patients who have not 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.
Other concerns raised in the medical practitioners survey included equality of physician licensing requirements. There are different licensing requirements for doctors depending on which local hospital they attend.
Concerns were also raised about government insurance provider CINICO not being able to offer choice of providers to the roughly 4,000 families it insures.