Editorial – A radical Rx needed for Cayman healthcare

Collecting patient bills is a major problem for the Cayman Islands Hospital in George Town, which has amassed tens of millions in unpaid debts over the past decade. – Photo: Taneos Ramsay

It’s a troubling sign for a healthcare system when the doctors are growing sick of it.

That’s the current status of the business of healthcare in the Cayman Islands, according to the results of a survey by the Office of the Auditor General of local health professionals (nearly all of them physicians or dentists).

According to the AG’s office, “The survey results point to overwhelming dissatisfaction with the financial aspects of the healthcare system including affordability, insurance reimbursement and payment collection methods.”

In testimony Wednesday before the Public Accounts Committee, Dr. Darley Solomon, a surgeon at Chrissie Tomlinson Memorial Hospital, described the Auditor General’s report as an “indictment” of the healthcare system in the Cayman Islands.

He warned that failure to deal effectively with the dysfunction in the healthcare industry could lead the entire country into bankruptcy. (In 2015, the Cayman Islands (both public and private sectors) spent approximately $269 million on healthcare, according to the AG’s report.)

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The doctors’ survey contains critical insights from a particular perspective into a healthcare system that is ailing on multiple levels, including the Health Services Authority, CINICO, private insurance, public health awareness, underlying demographic difficulties, governing legislation, licensing, regulation and the availability of technology.

We don’t have near enough space here to provide an exhaustive list of Cayman’s health problems, but we can call attention to some of the most troubling, such as the $95 million (and climbing) in “bad debts” owed to the public hospital system, most of it overdue from patients who couldn’t (or simply won’t) pay for services or drugs.

That accumulated debt would put most businesses, no, not in intensive care, but in the morgue.

The debt debacle can’t be blamed on HSA CEO Lizzette Yearwood alone. The issue long predates her tenure, and can be characterized more accurately as the dubious legacy of successive Ministers of Health, who have sat idly by or ineffectively for decades as the debt mountain grew ever higher.

Then there was the CarePay fiasco.

For readers whose memories may need a quick zap of the defibrillator, the CarePay patient swipe-card system (approved in December 2010 and implemented between 2011 and 2012) was supposed to stem the further accumulation of bad debts in the public healthcare system. Not only did CarePay never work as promised, but then-HSA Chairman Canover Watson (current address Northward Prison) used his position to divert CarePay-related contracts worth millions of dollars to his business partners, skimming some US$350,000 in public funds for himself in the process.

A jury convicted Mr. Watson of fraud and corruption charges almost exactly one year ago. He reportedly is planning to appeal his seven-year sentence.

Although CarePay’s tentacles of corruption and incompetence appear to spread far beyond Mr. Watson and his alleged co-conspirator Jeffrey Webb (who pled guilty to unrelated criminal charges in U.S. court in connection with the global FIFA corruption scandal, with his sentencing date set for May), thus far there is little evident progress on any follow-up investigations locally. As far as we can tell, Cayman’s authorities seem content with laying the CarePay matter to rest along with Mr. Watson’s freedom and reputation.

Other healthcare concerns that have been raised but so far remain unaddressed include the ever-escalating costs of private insurance to employers and individuals (with premiums rising despite the fact that standard health insurance fees paid to doctors have not increased since 2005), the public health system’s unhealthy dependence on charity to provide essential technology such as ambulances and medical equipment, and the gaping holes and inconsistencies in legislation governing the licensing and regulation of health providers.

Taken altogether, it seems it is time for a comprehensive examination of Cayman’s healthcare system, from the top to the bottom, perhaps with the assistance of a blue ribbon panel of experts from an overseas jurisdiction.

Let’s be serious: Band-Aids are not going to cure Cayman’s public healthcare problems. Our suggested prescription is more along the lines of radical reconstructive surgery.

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  1. I think you need to clarify your statement “that standard health insurance fees paid to doctors have not increased since 2005”. Doctors fees and charges to private sector patients, including the George Town hospital, have increased substantially since 2005 and they receive payment in full. The problem is that the insurance companies limit payment to the fee schedule legislated in 2005 (less the 20% co-payment) and the patient has to pay the difference on top of his co-payment. Government has consistently refused to update the fee schedule to reflect current pricing.

  2. Unless we begin shifting the top of this mountain, the Minister, and chipping away at all the corroded stones beneath, it will get bigger and bigger till it falls into the sea.
    I still say that all government employees except indigents, should contribute something monthly to receiving health care. Even if only 25.00 a month is automatically deducted from pay slip to their medical is worth the try. I don’t think the government should be taking up the complete slack on CINICO. and we will buckle underneath it sooner than later. Having medical insurance to me is greater than money in pocket.

  3. Roger you and Twyla are spot on , but that’s just how Government do things. Why aren’t the civil servants not contributing to their own health care ? But Government is doing it for them . I would think that the government is using that as a bargaining chip in for the Government and not the citizens.