(CNS): Finance Committee has approved millions of additional dollars for the health minister after he revealed that the budget for overseas tertiary healthcare for Cayman Islands people who are indigent as well as elderly seamen and veterans had already overrun its budget allocation at the financial year half-way mark. Committee members voted for the extra $8 million Dwayne Seymour asked for, but not before he was grilled by opposition members on what he was doing about spiralling healthcare costs, possible policy solutions and plans for a national system.
Seymour said that the extra cash was for the budget allocation that deals purely with the healthcare costs for this group of people who don’t have insurance but who are in need of overseas medical care, and the $8 million requested was to cover the second half of this year only.
In a statement to the committee justifying why he needed the supplementary appropriation, he said the number of indigents being taken care of by government had increased over the last six years from 1,100 to more than 1,600 who were now in need of temporary or indefinite support for medical needs. More than half of those were over 61, and of those 1,600 people, 907 were now permanently being covered. From that group of those with an indefinite need for support, more than two-thirds were over the age of 61, making it clear these costs were going to continue climbing.
He said the healthcare needs of people over 60 in Cayman justified his feasibility study regarding healthcare for older people and the need to provide better and more sustainable cover for this growing population. Concerns have been raised, however, that shaving off the older members of the community from insurance pools will make the current situation worse, not better, and that there is a pressing need for a national system using CINICO as the primary insurer.
Seymour also revealed that the segregated insurance fund, which was set up to collect contributions from the health insurance sector to help cover the cost of indigent healthcare needs, was collecting around $5 million annually, which was significantly below the amount government is spending on this group. The public purse is currently footing a bill of around $1.8 million per month on overseas healthcare alone for the indigent and elderly who are not insured.
Government is also covering around $1-2 million worth of local healthcare costs for the same group each month, separate and apart from this specific allocation for overseas medical referrals.
Although the committee supported the health minister’s request, he was questioned about the current policies and plans and whether it was time for government to introduce some form of national system. Seymour told the committee he was very uncomfortable with how things were and the spiralling costs. He admitted that he did not yet have a solution but said he was determined to find one.
The minister also revealed that there was no data, research, analysis or dependable information that could be used to justify a national system yet. He said discussions were underway at caucus level in government about the possible options for the future of health cover, but he said he was not ready to talk about that publicly yet. However, he did say that the discussions have included the idea of expanding the government’s insurance company, CINICO.
Despite having collected no information at all, the minister claimed that since being elected over one year ago, he had been looking at trying to curb costs and had been meeting with people to find a solution. He said it was an area he was working on and he had three years left, and even if he didn’t find a solution, he said he would have some ideas to put on the table for members of the Legislative Assembly to digest.
The government is spending in excess of $40 million per year on health costs for the elderly and indigent. However, members were also concerned about how far off budget allocations are, and Chris Saunders, the opposition member for Bodden Town West, pointed out that the prediction for this allocation was more than 70% wrong.
Seymour said he was “uncomfortable” with the costs, but the same thing happened last year and the year before that, as he insisted he was having conversations about what could be done. He described the issue of health costs for those not covered as being all over the place and that there was a “need to bring it to one place…so we can manage it better. There is no joy in talking about this out-of-control spending,” he added.
Seymour said that he was looking at everything, from older people to children, as he raised concerns that the insurance companies, which made a collective profit last year in excess of $55 million, were making profits on the backs of people’s health bills. He said it was “something we are looking at”.
The minister was grilled about why so many patients still had to go overseas to be treated and whether it was a question of incompetence or fear at the George Town hospital. Despite being the health minister and responsible for policy, Seymour said it was “not easy to get answers and drill down to the questions we need to ask”.
He said more studies were needed on how costs could be kept down and to get answers on why there were major differences in costs. He said he was looking at why certain overseas hospitals were being used when, despite giving the Cayman Islands Government discounts on service, they were often the most expensive facilities to choose. All of these issues, he said, were “not easy puzzles to resolve it but I am on it”.
The minister was unable to answer several questions from the committee about a number of areas under his responsibility, including the under-utilisation of the costly, medical robot that the HSA now has, and the fluctuating and inexplicable high charges on some medications at the hospital.
Asked how he did not know, given that he was the one bringing the budget allocations, Seymour said he had a “lot of fires to put out”. But he said he was “plugging away and I intend, as minister, to make a difference before the term ends”.