Government has budgeted $30.6 million to cover the costs of healthcare for uninsured or underinsured Caymanians in 2024, a sum that politicians agree is unlikely to cover those expenses.
Government, for many years, has had to find additional funding to cover medical care for indigents, which is often double the amount originally budgeted.
The issue came up at a meeting of Parliament’s Finance Committee last week, which was signing off on the two-year budget’s individual line items. For 2024, $12 million has been earmarked for medical care for indigents, and another $18.6 million for their specialised tertiary care at local or overseas institutions.
Health Minister Sabrina Turner told the Finance Committee that a “new strategic direction” was being implemented to help counter the growing costs of healthcare to Cayman’s ageing local population.
She said government was “putting the necessary guardrails up, trying to curtail this”, but admitted the impact of this would be unlikely to be seen in this two-year budget cycle.
Roy McTaggart, leader of the opposition, queried why only $12 million had been allocated for the coming two years for healthcare funding – outside of specialised tertiary care – for indigents, when it cost $27 million this year.
Politicians also addressed the notorious budget line item known as NGS 55, which covers the cost of tertiary care at medical institutions in Cayman and overseas for uninsured indigents, veterans and seafarers, and which has been an underfunded budget item year after year.
In this budget, $18.6 million in 2024 and $14.4 million in 2025 has been earmarked for this kind of in-patient specialised healthcare.
The projected spend for NGS 55 for 2023 is expected to be between $50 million to $52.5 million, McTaggart noted. The original budget set for this had been $21.5 million.
In 2022, the government spent almost $72.7 million on medical care at local and overseas facilities for Caymanians who were uninsured or underinsured – $39.7 million more than was originally budgeted.
Healthcare costs for indigents are predominantly paid for by CINICO.
‘New strategic direction’
Part of Turner’s new strategic direction is using preventative measures to tackle non-communicable diseases in Cayman, based on the finding of the STEPS national health survey, which was carried out earlier this year.
In an earlier budget-related speech in Parliament last week, Turner had stated that the ministry would be using the results of the STEPS survey to take a more data-driven approach to policy making and public health planning, and could provide a better understanding of the current barriers to healthcare, particularly preventative care.
Preliminary findings in the survey showed that almost 70% of Cayman’s adult population were overweight; that 1 in 20 residents were diagnosed with diabetes but were not on medication; and 1 in 59 people had previously undiagnosed diabetes.
This kind of data will assist the healthcare services in Cayman to “join the dots” and improve the health of the people in Cayman, Turner said.
‘Making full use’ of local resources?
McTaggart, questioning in Finance Committee the budget amounts allocated to healthcare for indigents, asked if the Health Services Authority and government were “making full use of the available resources and specialties available on island before sending people off island to Florida, which is for all intents and purposes, the most expensive jurisdiction”.
The majority of the payments for this kind of overseas medical care comes from the government’s insurance company, CINICO.
CINICO CEO Michael Gayle responded to McTaggart’s question, stating that about 75% of the expenditure spent on tertiary care for indigents is local.
“The protocol is where the service can be rendered on island, it is rendered on island,” he told the committee. “So, typically, what happens is that the patient goes to the HSA. If the HSA cannot provide the service, then we seek alternatives locally, and it is only when a service is not available locally that we send them overseas.”
West Bay West MP McKeeva Bush said, even though there may be facilities and medical professionals on island who can deal with cases, MPs are often approached by constituents to try to get the HSA to send them overseas for care.
“When a person is sick and… don’t want to go here, we representatives bend to their wishes and then we go put pressure on the services, so we have to bear that in mind. I do believe the cost that we are running up is far away from what it should be,” he said.
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