The number of people receiving government assistance for overseas or local medical bills has increased by nearly 50 percent between late 2011 and this year, the Legislative Assembly’s Finance Committee was told Tuesday.
Health Minister Dwayne Seymour revealed that more than 1,600 people were receiving permanent or temporary assistance with their healthcare coverage at either non-Health Services Authority facilities in Cayman or at overseas hospitals as of May 2018.
In November 2011, that figure was about 1,100 people.
The cost of their medical bills at overseas or non-public medical facilities in Cayman was expected to exceed $21 million for the entire year, according to Minister Seymour.
That figure does not include the estimated $12 million to $24 million already being spent at public hospitals before those individuals are referred to private facilities in Cayman or overseas medical care facilities for treatment.
The 1,600 people identified as “indigents” – those without a healthcare plan – did not include Cayman veterans and seamen, who also receive government assistance for healthcare provided at overseas facilities each year.
The numbers were presented as Minister Seymour tried to convince finance committee members to support an additional $8 million in spending on indigent healthcare in the current budget year as costs continue to rise and could put government in danger of not paying hospital bills later in the year if these were not covered.
“Delaying or denied medical care for seafarers and indigents presents a significant liability to government,” Mr. Seymour said. “If their condition deteriorates [due to a lack of funding for care], the high probability is their family would file a complaint against the government.
“Inability to meet financial obligations to the overseas healthcare providers could affect the relationship with these providers,” the minister said. “Patients referred by government could be denied access to critical care.”
The latter outcome could affect the entire government service healthcare coverage plan, not just what is provided to indigent Caymanians, Mr. Seymour said, if overseas providers become reluctant to do business with the Cayman Islands.
Some legislators proposed increasing an annual tax on private sector insurers under the standard health insurance contract to help cover the costs. Right now, people insured under private sector plans pay $10 per individual and $20 per family per month toward indigent healthcare – raising about $5 million per year.
However, with costs for coverage now in the region of between $40 million and $45 million per year, those charges do not come close to covering what taxpayers spend on indigent care each year.
“This amount of money is just absolutely phenomenal,” Savannah MLA Anthony Eden said.
“We cannot continue this.”
“The healthcare companies make $50 million profit on insuring 40,000 working people … and then as soon as someone retires from the private sector, they become government’s problem,” said Bodden Town West MLA Chris Saunders.
Minister Seymour noted that more than two-thirds of those indigents receiving permanent healthcare coverage from government were over age 60.
He said the government had not seriously considered proposals to “nationalize” Cayman’s healthcare coverage, but he noted either that option or expanding coverage provided by the Cayman Islands National Insurance Company, which currently insures most government workers, might have to be considered.
“Every year we continue coming for this [spending item],” he said. “The responsible thing for us to do as a House is look at ways to stem this cost.”
Civil service plan
One option that is not being considered to better fund government-provided healthcare is making government workers pay a portion of their own coverage premiums.
This proposal was raised by the previous Progressives administration in 2014 but died after Deputy Governor Franz Manderson said earlier this year that there was “no support” for such a move.
At present, all civil servants, their spouses, underage children and civil service retirees receive 100 percent free healthcare coverage, as long as they use the public hospital system. Government taxes and fees are used to fund tens of millions of dollars each year in healthcare payments on behalf of civil servants.
A review of healthcare liabilities completed in late 2017 had looked at how much the government expects to owe for health costs in the next 20 years, as well as how much taxpayers are funding public sector healthcare annually.
In 2014, the government estimated its present value healthcare liability for both current and retired civil servants would be $1.18 billion over the next 20 years.
By June 2016, those future liabilities were estimated to have increased to $1.4 billion and last year, to nearly $1.7 billion.