Hospital tries to clamp down on debt

| 31/03/2015 | 21 Comments
Cayman News Service

Cayman Islands Hospital, George Town

(CNS): As the hospital continues to battle with bad debts, the chief executive officer reminded the Public Accounts Committee recently that the Health Services Authority has an obligation to treat everyone in need of medical attention first and deal with the issue of costs later. Lizzette Yearwood said that the hospital has made strides collecting debt on elective procedures and ensuring payment for non-emergency treatment but when it comes to medical need, the hospital boss said they had a mandate to deliver care, whatever the patients’ circumstances.

She said the hospital was systematically working towards minimizing bad debt and trying to improve collection and payments in each of the departments. The focus has begun with elective surgery in the operating rooms and the next big push would be at the pharmacy and the need to collect payment for drugs, she explained.

However, Yearwood said there had to be a change in the culture in Cayman before the hospital would be able to truly address the bad debt, which officials predict will be around $70 million at the end of this financial year, because many people still feel healthcare provision should be free.

“But we are trying to change that culture so people get their cover,” she added. People turn up frequently at the hospital with no insurance cover, despite the law mandating that every person in the Cayman Islands must have health insurance, the hospital boss said.

Those who are not working or unable to pay should be covered by the Cayman Islands National Insurance Company (CINICO). Yearwood said that when they have patients with no insurance they refer them to the Needs Assessment Unit and are working with that department to communicate where people need help.

Among the financial challenges the hospital faces was the cost of its own insurance bill. Yearwood said that new employees no longer have health cover for life as part of their benefits package but she warned that would create further challenges for government when these people retire.

“What will they do in future?” she asked, as she warned that it was something government had to think about.

Wherever government cuts debts or makes savings involving payments in one area, unless the people are able to find the money themselves the government picks up the tab at both ends.

While government is helping the hospital cope with its bad debt due to none payment, it also has to cover the contributions of health cover for those who are not working, elderly or indigent via CINICO. During his time appearing before the PAC last week, Lonnie Tibbetts, the CEO of CINICO, pointed to the significant percentage of clients who are permanent indigents funded by government, as well as the emergency or large catastrophic medical needs for people who are financially challenged that CINICO must cover. He said managing that remains problematic for the government owned insurer.

Tibbetts warned there was no single easy fix as the people seeking government assistance for medical care continues to grow and in every budget cycle the fund requires extra appropriates because the predictions are never accurate and it was always more than budgeted and underfunded.

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Category: Health, health and safety

Comments (21)

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  1. Anonymous says:

    Until the billing process is done properly nothing will change.

    I have just received a statement for an X-ray my son had in January! I wasn’t asked to pay anything at the time (I do have health insurance) but 3 months to receive the first notification that you owe anything is ridiculous.

    I also noticed that despite the sign saying you needed to show ID plus a Cinico card to receive Cinico benefits, not one person did.

    • Anonymous says:

      As a follow up to this comment, when my husband went in to pay this “statement”, he was told that we also owed for something else from 2010 for our son!! This was also the first notification we ever had for this charge. Why was this not on the statement?

      There seems to be no process of invoicing going on – no wonder the HSA is owed so much. When I go to any other health provider, my insurance is checked before I even see a doctor.

      People who don’t want to pay their bills must love the HSA, no wonder we have such “entitlement” going on.

  2. Anonymous says:

    I was told recently when I visited HSA that I have an outstanding bill of $600+ from 2010 that my insurance didn’t cover at the time, and was not aware of this. I would have thought that someone would have notified me of this prior to 2014 and not wait until 4 years later when I so happen to go to HSA for a doctor visit. Go figure!!

  3. Anonymous says:

    Hey – how about you actually pursue the debtors through the courts like the private sector would! You never do, so no one has to pay, so many choose not to. Being too nice for too long has its consequences. Dat wa u get!

  4. Sam says:

    Writing off millions (billions) is what CIG does very well. Knowing where it came from is another story.

  5. E.Stenna says:

    How can HSA collect outstanding fees if they do not invoice patients? I know someone who spent 4 days in ICU in 2012 and to date they have not received a bill. I don’t believe they are chasing HSA for the bill.

  6. Anonymous says:

    They really need to look at the controls they have in place. My husband spent two days in hospital last week. He was discharged on Saturday and I asked where I go to pay. The nurses scratched their heads and said I don’t think you can pay on a Saturday. Now I’m going to have to go back to find out what we owe and pay it. When we registered, they didn’t verify mailing address or phone number so they’d have no way of tracking us down. I gave them an insurance card but realized after it was an old one when I went to pick up a prescription at a local pharmacy and they told me it was an old card. Then I found the new one in my wallet. HSA didn’t mentioned anything wrong with that old card when we registered him. Great verification controls HSA! I’ll be honest and go in but otherwise, we would be just another couple thousand added to that growing receivables number!

    • Anonymous says:

      Exactly right. In America the ER admits you right away as well but before you even leave or enter they want ID, insurance info, address, social security number, a way to contact you and they have someone come and talk about the costs Of Your visit all before you’re allowed to leave. And of course if you don’t pay or arrange insurance payments it negatively impacts your credit score. Which holds each person responsible. CI government needs to step out of this old warped system they use and get with the program. These are petty mistakes that are costing them millions. Nobody’s fault but their own. Who’s head/in charge of accounting and billing dept? Sounds like y’all need to recruit some new employees with better knowledge and experience to get the job done!

      • Anonymous says:

        I agree with 12:50 they need to recruit new employees with better knowledge and experience but they prefer to hold on to the non performers who will not challenge what they are doing.

  7. Anonymous says:

    You mean if the culture (if that’s what you want to call the people of the Cayman Islands) pay their bill then that would help bring down the bad debt. What about trying to collect from those that have had free oversea air ambulance, free overseas hospital care, free overseas doctor care why doesn’t HSA try to collect that debt from those patience that’s where most of the bad debt comes from. Don’t tell me that you do collect from the overseas care. Then how come HSA owes so much to the overseas hospitals.
    Also, I have been calling now for the pasted three years for a bill so that I can see what my bill was when I went to emergency one day and I have yet to receive it or even received a bill in the post????

    • Anonymous says:

      It would take organization skills for that to happen, something that is sadly lacking here on our beautiful God blessed island.

  8. Anonymous says:

    I went there @ 4am in 2009 at 5 months pregnant. They told me I could not be seen by a doctor there and they tried to call my gyno (to no avail and I left). Anyway, I made it through the discomfort and saw my gyno (a private dr. @ his clinic) later in the morning. Months later they sent me a bill for the doctor visit I never had.

  9. Just Sayin' says:

    If it takes them 12 months to send me a bill I will wait a further 24 before paying it.

    • Diogenes says:

      That’s the spirit. Great to have such community commitment. Why don’t you just the pay the bill at the time rather than rely on the shortfalls of the HSA result in the rest of the community having to pick up your bill?

      • Senegoid says:


        So how does HSA collect from the prisoners at Northward and Fairbanks or the Cuban Refugees who are kept here for long periods of time? And what about the Expats employed by Government who spouses and 2 children are allowed to receive free medical and dental?

        • John Maynard Lenin says:

          And, Senegoid, what about the 18 million dollars-I’ll repeat that, 18 million, that CAYMANIAN-I’ll repeat that too, CAYMANIAN- indigents cost Government every year. At least the expats are doing a job and getting their medical benefits as a result of their employment terms; the indigents get it from doing NOTHING other than being doped up, boozed up, lazy sons of you know what with their hands stretched out for money. And all this in the fifth most successful Financial Centre in the world with one of the highest GDPs blah blah blah.

        • Anonymous says:

          Its not free it’s Cinico that pays

        • Anonymous says:

          So you think that the dependents of expats should not receive any medical cover? What would make you think that someone would come here without a basic right to medical care. You are already having difficulty attracting people to your island and no medical cover would kill foreign workers coming here.

          • Anonymous says:

            They are required by Law to have insurance. It is a condition of the grant of their approval to be here in the first place!

        • Anonymous says:

          I do not have a problem with expat spouses & children being covered – I just think they should have to pay an insurance premium as we have to in the private sector. In fact all Gov’t should have monthly premiums deducted from salaries (Caymanians & Ex-pats). Those with the free medical are the same ones who criticize the service they get at the hospital which they aren’t even paying for. I’m just so baffled by this. As they say – you get what you pay for!

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