Health insurance enforcement ‘suffers’ from underfunding

Cayman’s health insurance regulator will receive one additional inspector shortly, but senior civil servants acknowledged that will not solve the beleaguered agency’s troubles in keeping up with demand in a growing local healthcare industry.

The Cayman Islands Auditor General’s Office reported Monday that Cayman’s Health Insurance Commission still has the same number of inspectors – three – that it had when it was formed more than 12 years ago.

Ministry of Health Chief Officer Jennifer Ahearn told the government’s Public Accounts Committee on Wednesday that since 2004 the number of health practitioners in the territory has significantly increased and neither the Department of Health Regulatory Services nor the commission has been able to keep up with demand.

Public and private sector healthcare professionals told the auditor general’s office in its recent report that they had serious concerns regarding government’s “capacity shortages” in a number of health regulatory areas.

Auditor General Sue Winspear said enforcement of compliance with the Health Insurance Law has suffered as a result of short staffing, and that “the risk of some employees and their dependents being uninsured has increased.”

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The government reports that 94 percent of all Cayman residents maintain health insurance, up from about 87 percent in 2010. However, the Health Insurance Commission noted it largely depends on proactive complaints about healthcare coverage not being provided before investigating a specific matter.

“What appears to be a relatively small number of fines imposed by either the Health Insurance Commission or the courts must be interpreted in light of the fact that [the commission] does not have the resources to go into the field and carry out inspections of employers,” the audit noted. “Several officials and practitioners we interviewed believed that neither the administrative fines imposed by the commission nor the fines imposed by the courts are sufficiently punitive to encourage compliance.”

Public Accounts Committee Chairman Ezzard Miller asked Wednesday whether the health commission had made requests for additional staff and if those had all been refused since the agency opened in 2004.

“Every time I pick up the newspaper there’s ads for staff, and some people seem to be getting all the staff they want,” Mr. Miller said, adding that he thought the enforcement of local health insurance requirements was among the most crucial services the government provides.

“You can’t tell me that an extra plane to Cayman Brac is more important than that” he said.

Financial Secretary Ken Jefferson told the accounts committee that while requests for additional staff get made by many government agencies each year, it was rare for those initial spending plans to be left “intact.”

“Nine times out of 10, it’s going to be reduced,” Mr. Jefferson said, adding that the Health Insurance Commission may well have suffered from budget restrictions the territory is operating under.

“You need to maintain surplus, you need to maintain cash balances in the year, you can’t borrow … so the focus is back to the level of expenditure presented,” he said.

Performance audit manager Martin Ruben said the auditor general’s office reported in 2013 that government, while maintaining a healthy budget surplus each year since 2012, has not always understood the ramifications of its budget reductions.

Mr. Ruben said there were “significant gaps” between the government’s annual strategic policy plan and the resources it has to implement that plan.

“There’s a lack of ability to assess the impact the reductions are having,” he said.

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  1. If Government only finds out about lack of health insurance when someone complains, how can they claim that 94% of the population have coverage?. This figure seems hardly believable even taking into account the vast number of civil servants and their dependents.