How should the next government tackle health insurance costs?

| 02/03/2017 | 16 Comments

(CNS Elections): How to pay for the cost of healthcare is a major headache for all countries, large or small. In the US, the promised repeal of “Obamacare” is proving much harder for President Donald Trump than he thought, because millions of people who are now covered under the Affordable Care Act could be left stranded with no way to pay for their medical bills. On the other side of the Atlantic, Britain is struggling to maintain the National Health Service, where treatment is free for all.

Here is Cayman, the current system of mandating private insurance through people’s employer has left certain groups in a precarious position, such as retirees, who lose their health insurance just as they need it most, and people with a pre-existing condition, who are charged exorbitant fees.

If people actually claim on their insurance, their healthcare costs can go up dramatically, not just for that person but for all their co-workers on the same plan. This means that not only do people with health problems have to constantly worry about medical bills but they might also find it harder to get a job, since small businesses especially may be reluctant to take them on as it will make insurance for all their staff unaffordable.

When the Cayman Islands National Insurance Company (CINICO) was first launched during the first UDP administration, the promise was that it would start with coverage for civil servants and indigents and then later be extended for all. This never happened. CINICO does not even cover all public servants, as each government company and statutory authority is free to chose its own insurance company.

So now the situation is that the private insurance companies largely cover the working healthy population of the Cayman Islands, while in addition to civil servants, the government covers the old and the sick.

But CINICO can also terminate the insurance for people on its basic plan, the Standard Health Insurance Contract (SHIC), if they miss one payment. “If a Participant fails to pay premiums within 30 days of the due date or the policy lapses for any reason not authorized, the Participant’s policy will automatically be terminated.” So theoretically, someone who loses their job due to ill-health and is struggling to pay their bills can also lose their health insurance.

On the other hand, a government-funded healthcare system that is free for all is open to abuse, over-use and could implode due to the weight of funds needed.

During the last election there was very little discussion about health insurance. However, Opposition Leader McKeeva Bush has opened the door for serious discussion during the upcoming General Election (see Health insurance costs come under political fire). It remains to be seen if candidates and parties can outline detailed solutions to the issue — and how to pay for them — as well as point out the problems.

Healthcare insurance costs are often not thought about until people get sick, and then if they are unable to pay, the results can be devastating. Unlike Trump, however, most people understand that this is a complicated topic and the electorate should be looking to the candidates for viable solutions.

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Comments (16)

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  1. Anonymous says:

    Get rid of CINICO and go back to how it was handled years ago.




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  2. Anonymous says:

    The article says NHS is free for all….Not 100% accurate as it is funded from General Taxes paid by the people.




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  3. Hippocrates says:

    ‘Government’ pays the police and teachers: it should pay doctors and nurses as well!




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  4. alan mathews says:

    As someone who used to be Guernsey resident. I suggest a system that they have may be a good solution for the Caymans. All residents in work below the age of 65 and over 16 unless in full time education. must contribute to a government pension scheme and a health scheme, fees are related to income.
    The health scheme pays for all hospital care and doctors fees at the hospital.
    General Practitioner fee visits cost $100 per visit .Drugs are limited to $20 per item. Initial visits to the emergency hospital room cost $200.
    Dental care is 100% private.
    This is not as generous as the UK nhs but provides a level of security for the citizen as to high costs and stops frivolous trips to the doctor.
    Private insurance is not involved.
    The current system on the Caymans is unsustainable.




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    • Anonymous says:

      As we do not refer to the Channels please do not refer to the Caymans. Those places do NOT exist.
      Otherwise it would be interesting to hear more about how this system really works.




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  5. Anonymous says:

    Ensure Civil Service pay their share




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    • Anonymous says:

      They already do.
      (Its part of the pay package. If you cut it, its a pay cut. So people either leave or Govt. has to pay more cash to retain/attract staff.)




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  6. Anonymous says:

    Attack diabetes with heavy sugar tax. Maybe set up a Cuban version of Health City for the main Govt hospital.




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    • Cathy Church says:

      Sugar does not cause diabetes, it only exposes that eating animal products and fats has damaged the pancreas. We need to tax animal products and eliminate virtually all type II diabetes.




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  7. Clearasmud says:

    There are 70,000 people living in Cayman. Let’s say there are 4 people per household. That gives 17,500 households. If each household pays $300 per month for insurance coverage, that is $5,250,000 per month or $63,000,000 annually. I therefore suggest that every household should pay $300 per month to the HSA for health coverage and every person in that household is entitled to any medical treatment available at the HSA. For those who can afford supplemental insurance, or any other insurance, they are free to purchase it, but they must pay the $300 monthly to the HSA. That would be a win, win for everyone. The HSA doesn’t have to worry about getting paid for services provided and the population has access to excellent medical care when needed.

    This of course does not cover specialist care not available at the hospital and a solution to that would have to be examined, but the above is a great start because that is where the majority of the care falls and is required.




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    • Anonymous says:

      Clear as mud, there is a huge sieve at the HSA, every penny leaks out. National insurance is the best way to go.




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    • Whatcha Say says:

      What about ‘households’ subsisting on below the poverty level and having income just barely above this $300 contribution? I know of at least 10 such situations in my limited social group! One person I know is living on under $200/month total income from a small pension. What about these cases, which are fairly common nowadays?




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  8. Anonymous says:

    We can get better insurance with more benefits and less unreasonable exclusions at CONSIDERABLY reduced premiums to those we pay here, if we could buy our insurance abroad, outside of the Cayman cartel!




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  9. Anonymous says:

    I’m between ‘improve system’ & ‘NHS’. The NHS can still be run through the private firms or with them providing ‘AFLAC’ coverage over and above what gets covered on SHIC. Running the NHS through them means that they all have to offer a basic SHIC package at a set price. Or they become re-sellers of the CINICO-SHIC (like an insurance broker for car insurance). That is probably the simplest system. If you want additional coverage you go to the private insurance company that sells you the CINICO-SHIC and then whatever additional coverage you want to pay for. If you want you can cut out the middle man and go straight to CINICO but there should be no difference in price. (I don’t know how the insurance brokers do it for my car but we should be able to recreate the system for health care.) The private companies can still compete on price & service for the additional coverage, thereby meaning that people can get the benefits of the free market with the reassurance of the NHS.

    This doesn’t solve all problems. The country still has to argue about what we think SHIC (NHS) should cover at what cost. And whether premiums are paid for by taxes or there’s a means-test to get Govt. to pay for it for some people (like with housing assistance, etc., now). But it gives Government a set, capped, cost & income for national health insurance. Anything beyond that is political. Because the big problem with health insurance is choosing between death panels (Govt. can’t pay you die) or death poverty (can’t pay for it yourself you die). But at least it gives us a method to address this issue head-on and say that ‘for things SHIC doesn’t cover there is palliative end-of-life coverage in SHIC’ and accept that one way or another some people will die because we individually or nationally can’t pay to keep them alive. But we can afford to help them die with peaceful dignity.




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  10. Anonymous says:

    Agreed. Allowing more competition is always the key to lowering prices.




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  11. Anonymous says:

    Allow residents access to off island providers for healthcare coverage.




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