(CNS): The government has confirmed that fees paid to doctors for health services won’t increase in the short-term after most local healthcare providers failed to engage in a survey to review medical costs that could have seen them get more cash. The results of the work by medical consultants engaged by government indicate that the man in the street will soon be paying at least 12% more for health cover if the local health system is not fundamentally changed, as the consultants found fees are too low to cover costs. But with less than a quarter of healthcare providers taking part in the review, Cabinet said it is not prepared to make any changes yet.
On Thursday, the health ministry released a report by Morneau Shepell, the firm contracted in May last year to carry out a survey to review healthcare provision and insurance fees to determine the costs associated with operating a medical practice and billing procedures. It was meant to give government information to justify an increase in fees if needed.
While the consultants have recommended increases in various fees, which would result in an overall 12.3% rise in costs across the healthcare system, officials said Cabinet has decided to postpone any increase in fees until doctors engage in the process. It now plans a another review next year, for which it hopes to persuade more physicians and other healthcare providers to participate so that meaningful conclusions can be drawn on the data.
Out of the 139 physicians and 67 health practices contacted, only 50 responded and not all completed the survey. Less than 10 of those 50 who responded provided financial information to the consultants to give an understanding of the cost structure for operating a medical practice.
“This made it extremely difficult for the consultants to have a high degree of confidence in determining a reasonable level of cost of operating the medical practices,” said the councillor in the health ministry, Roy McTaggart. “As a result, it was very difficult to establish a fair level of fees for services provided by the healthcare provider. We commend those healthcare providers who did respond to the survey but unfortunately it was not sufficient.”
As the Standard Health Insurance Fees have not been increased for many years, government said it is still willing to review the fees again next year if providers fully participate in the survey at that time.
“We need the healthcare providers’ cooperation to do this as we can only determine a fair level for the fees based on the information they provide us with,” said Ministry of Health Chief Officer Jennifer Ahearn. “We urge the healthcare providers to be forthright in providing this information, which is held in strict confidence by the actuaries conducting the survey, so that we can work with them to ensure that a fair level of fees is implemented.”
Standard Health Insurance fees are the list of fees approved by the Health Insurance Commission that an approved insurer is liable to pay under the Standard Health Insurance Contract for a healthcare benefit provided to a compulsorily insured person. Under the law, every healthcare facility and registered practitioner must file with the Health Insurance Commission annually the maximum fee charged for each health benefit provided by the facility and the registered practitioner.
But the current system operating in Cayman is coming under increasing criticisms from all sides except for insurance providers. Currently, insurance costs for most people are becoming prohibitively expense but the law mandates everyone must have health insurance.
While government and most public authorities pick up the full tab for comprehensive insurance cover for its employees, most workers in the private sector are less fortunate. While professionals and management may work for firms willing to also cover their costs, workers who are fortunate enough to have bosses who follow the law and provide cover are still required to pay half of the premium and in addition are often faced with deductibles and additional non-covered costs when accessing medical services because of the inadequacy of the SHIC plan.
Insurance firms have also been in the habit of declining cover to people with pre-existing conditions, leaving the government’s own insurance company to cover those individuals indebtted to the government hospital.
See the report in the CNS Library