Free healthcare has to stop, says minister
Cayman News Service, September 8, 2011
One of the biggest obstacles for providing affordable and sustainable healthcare in the Cayman Islands is the prevalent entitlement culture, according to speakers at a press briefing launching the island’s second annual healthcare conference, which is to be held later this year. Health Minister Mark Scotland said that government policy had been to blame, which allowed everyone healthcare, regardless of whether they could pay or not, and regardless of whether that healthcare required expensive overseas medical care. Chief Officer in the Health Ministry Jennifer Ahearn said that Cayman needs a cultural shift.
“One of the biggest challenges is the culture whereby patients expect that they should be treated and not have to pay for it. The bad debt the Health Services Authority has been dealing with is significant and a lot of it is due to patients not taking responsibility for their healthcare,” she said.
Scotland confirmed that the cost of healthcare to the government was $90 million and rising, with around $25 million of this covering those who could not afford to pay for medical bills themselves, along with healthcare for civil servants, seaman and veterans and pensioners.
Scotland said that the HSA itself was now profitable since government had begun purchasing a lot of outputs, i.e. services that otherwise could not be paid for by the patients, such as care for the elderly or paediatrics. “The HSA is in the black but at the expense of government,” he confirmed.
Dr Steve Tomlinson, founder of Cayman’s private hospital, the Chrissie Tomlinson Memorial Hospital, told CNS that public expectations of healthcare were extremely high.
“The first place they want to go to is the US – they expect this at the very least if the care is not available here. And it is government that ends up paying for it,” he said.
Dr Tomlinson went on to discuss the individuals who were entitled to free healthcare apart from indigents, including seaman and veterans, and stated that these individuals and their spouses were not means tested and entitled to receive free healthcare regardless of their income. “Some of these people are very rich,” he confirmed.
The doctor vowed he would be speaking more on the drivers of escalating healthcare costs in Cayman at the conference, entitled Healthcare 20/20 2011 and taking place from 17 – 19 November at The Ritz-Carlton.
Scotland went on to say that any losses incurred by the HSA were not due to any poor business practices on the part of the authority, but due to uncollectable bills.
Chamber of Commerce CEO Wil Pineau echoed his support for the HSA, saying he felt that the authority had become business-friendly under its CEO Lizzette Yearwood and Medical Director Dr Greg Hoeksema, reaching out to the public and providing education about healthcare.
Scotland said the culture of Caymanians only seeking to go to hospital when it was in an ambulance also had to change because waiting until a serious medical situation took place was far costlier than taking preventative measures. Dr Tomlinson agreed and said that although there was not a huge volume of individuals who wait until their condition becomes critical before they seek healthcare, those that did usually ended up being sent abroad, vastly increasing the cost of their healthcare.
“Ninety per cent of them end up dying anyway, even once all that money has been spent,” he confirmed.
Ahearn said government was attempting to deal with these issues by a concerted public awareness campaign on preventative measures as well as amending the health insurance regulations.
“The current basic level of mandatory health insurance doesn’t have a robust enough package of benefits so people often exhaust their benefits then fall into the underinsured category where they won’t be able to meet the costs,” she said, explaining that an enhanced, and therefore more expensive, package was needed.
Scotland acknowledged that the current economic climate was a difficult one but said that with this public awareness campaign, businesses (which are required to pay 50 per cent of their employees’ insurance premiums) which will have higher insurance costs imposed upon them should realise that small increases in costs now should equal to savings in the future, as workers will need less time off due to ill health, especially if they take advantage of wellness packages built into the new insurance packages.
Ahearn added that employers needed to think seriously about the high cost of healthcare, especially the astronomical cost of sending an employee abroad by air ambulance, for which they would have the responsibility. “While there are going to be some higher costs, it’s something we can’t afford not to do,” she said.
The Healthcare 20/20 2011 conference, under the title ‘Healthcare Economics: the search for quality & affordability’ will feature international and local speakers, including Health Minister Mark Scotland and HSA CEO Lizzette Yearwood, as well as Dr Jennifer Attride-Stirling, the CEO of the Bermuda Health Council, the Hon Elinor Caplan, CEO for Canada Strategies and Renee-Marie Stephano, the president of America’s Medical Tourism Association.
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