Compass Point - Healthcare: The myth of free health care
Cayman Compass, November 3, 2011
For many in Cayman, free healthcare has become an expectation - one that stands in the way of a long-term sustainable health system.
Each year, the Cayman Islands Government pays more than $90 million for healthcare, including medical bills and insurance for its civil servants, pensioners, seafarers and indigents.
The theme of an upcoming national health conference in Cayman this month is Healthcare Economics: The Search for Quality and Affordability and Ministry of Health organisers of the conference admit that one of the barriers to making healthcare affordable and sustainable in Cayman is the belief of many residents that they will always have access to free healthcare.
At a minimum, employers are legally required to provide employees with a standard health insurance contract. Those who do not even have that minimum level of health insurance, such as self-employed people or the unemployed, frequently fall back on the government’s Cayman Islands Insurance Company, or CINICO.
Lonny Tibbetts, chief executive officer of CINICO, explained, however, that it is a common misconception that CINICO just provides the insurance free of charge to indigents or those who cannot afford insurance normally. Those people are required to sign an undertaking that they will repay the government, he said.
“Some have no means to pay it back,” he admitted.
The downside to this “free” health insurance is the delay in acquiring it, as it has to be approved and applications need to go through a bureaucratic process, Mr. Tibbetts said.
The guarantee to pay the government back could also leave the individuals in debt, he said.
Another threat to Cayman’s quest to attain affordable, sustainable, quality healthcare is its growing elderly population.
As people live longer, they need more medical treatment for the diseases associated with old age.
Right now, pensioners in Cayman are covered by CINICO’s SHIC plan. The SHIC1 plan covers a maximum of $100 per calendar year for checkups and primary care, $100,000 a year or $25,000 per individual medical incident - amounts that are unlikely to cover ongoing illnesses that require intervention such as surgeries and overseas care or intensive, long-term treatment.
Mr. Tibbetts said CINICO, the government and other parties were working to come up with a plan that would ensure that people would be covered once they reached the age of 60.
He said the parties were examining “the development of alternative insurance plans” for civil servants and other citizens.
As Cayman’s population ages, the need for healthcare will continue to grow and the government cannot continue to pay for that healthcare. “Our health system cannot sustain that. It’s a significant challenge,” said Mr. Tibbetts.
According to the Health Insurance Law, employers in the private sector must provide, at least, a standard health insurance contract for employees, their dependant spouses and children.
Employers can deduct up to 50 per cent of the premium cost of the insurance premium from an employee’s wages.
CINICO covers all civil servants, as well as people aged 60 or older; anyone rejected by two approved health insurance providers in the previous 60 days; and low income individuals, who can provide evidence of an annual family income of CI$40,000 or less.
Minister of Health Mark Scotland announced earlier this year that a healthcare cost review committee had been set up to look at how overall cost of healthcare can be reduced.
The Health Services Authority has also set up a system called Cayhealth that focuses on preventive measures and primary healthcare to take pressure off emergency and acute care services, with aims to finding health problems within the population before they have to be addressed in the hospital’s emergency rooms.
Speaking at the September announcement of the launch of the 20/20 health conference, Mr. Scotland said: “Everyone needs to understand there must be a culture change. Patients need to become more proactive in managing their own healthcare. Physicians need to be more engaged with their patients. Both of these parties will have to become more involved in how the medical industry is financed.”
To do so, the Cayman Islands and its Health Services Authority would have to accept that the national healthcare system would have to operate more like a free market.
While there is traditionally reluctance by the public to pay more in insurance costs, in the long term, such increase would lead to saving, Minister Scotland said.
The healthcare cost review committee is exploring how to “incentivise” civil servants and other members of CINICO to make co-pays or have options to go outside the Health Services Authority for their healthcare.
This is part of Compass Point - Healthcare. Please click here for more stories on this topic.
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