Notorious healthcare bills climb to new high
(CNS): The public purse will be picking up a record-breaking tab by the end of this year to cover the hospital bills both at home and abroad for people who are either under- or uninsured. Although the 2021 Census suggested that 93% of Cayman Islands residents have health insurance, in 2023 the government is expecting to pay hospital bills of around CI$78 million.
When members of parliament met Tuesday in Finance Committee to vote for another CI$68.8 million in public spending for this year, that vote included an additional CI$32.2 million for healthcare, on top of the original CI$33.5 million and a further CI$13.5 million approved by Cabinet in July. Split over two appropriations, one for the Health Services Authority and the second for private sector hospital bills here and abroad, the supplementary expenditure led to a number of concerns from the opposition benches.
Sir Alden McLaughlin (RED) pointed out that the government pays around $3 million per month in medical bills for the indigent at the George Town hospital alone and said it had to ensure that a more realistic amount is budgeted in the first place. He said the line item for the “notorious NGS55”, the provision of non-HSA tertiary health care for indigents, seamen and veterans who are referred for treatment locally and overseas, was more than double the original budgeted allocation of just under CI$21.6 million at over CI$52.4 million.
Chris Saunders noted that 93% of the population is paying over $300 million in premiums to private health insurance companies. According to CIMA, at the end of 2022, the health insurance sector had collected US$403 million in premiums. Saunders said we had “privatised the profits and socialised the losses”, and at some point, the government had to “put its foot down”, as he pointed to the need to expand CINICO.
“We have to take care of our people, but the people can’t continue being burdened by the fact that people have inadequate insurance in this country and are resorting to the government to make up the difference,” Saunders said. He added that bringing more people under the CINICO umbrella could help spread the risk.
According to CIMA’s latest figures, private healthcare companies earned over CI$403 million in premiums last year.
Panton said these two appropriations had been a challenge for all governments, and it was the same challenge for PACT. He said that the increasing focus on preventative care would help mitigate the continued increase in this budget.
MPs also voted for additional funding of CI$8.8 million to cover premiums for civil servant pensioners and their dependents for the last part of the year. Gloria McField-Nixon, the chief officer of the Portfolio of the Civil Service (PoCS), said this was to cover premium increases as well as an increase in the number of people insured.
The amount of money the government spends on healthcare for those who cannot afford adequate or any insurance has increased every year, and there are major concerns that the current system is not working for anyone except for the insurance companies that are making a profit, which has been in excess of $50 million in the past and was over CI$48 million last year.
Health insurance is mandatory in the Cayman Islands but most people working in the private sector have the Standard Health Insurance Contract (SHIC) plan, which currently costs $167 per month for a single person and around $600 for a family, but can be much more for older dependents and is extremely limited in its cover.
As a result, as well as paying for people who are unemployed or retired and cannot afford their own health insurance, the government is picking up the tab for those who have maxed out their SHIC plans because of a serious medical incident or long-term health problem.
While the idea of making CINICO, the government-owned insurance company, the universal insurance provider has been discussed over the years, no government has been willing to take on the insurance companies to make that change.
However, with the current rate of spending, by the end of next year, the cost to the public purse for hospital bills could be as much as $100 million.
See the appropriation request in the CNS Library.
Watch the Finance Committee proceedings on CIGTV below:
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Category: Government Finance, Health, Health Insurance, Politics
lots of men never left home to work on ships,and some only went for a few weeks but they all getting the Seamen benefits of medical and the monthly money.Government never checks to see if they are ex seamen or not.
9.25pm The bigger problem is their current wives and their basketload of kids reaping benefits. The only persons who should get any benefits are the Seaman himself and the wife he was married to whilst at sea. when they pass away all benefits should cease.
Whenever Government gets CINICO to take over the medical insurance in Cayman I’ll join. I will be 70 yo in 2 months and it is cheaper to catch a plane to Panama and pay one third of what it costs here. They want me to pay 600-2000 per month and get one free consultation per year, really? US$10,000 for 2 implants here US$3100 in Panama. CI$400 and trip and rent an AIRBNB for US$400 per week. Take an uber for US$3-4 to hospital or dental. Enjoy Caribbean food and drink, watch a show, sit on the beach and still didn’t come up to US$10,000??? What’s wrong with this picture? We don’t have any taxes? Why 3 times any country in this area? Thieves!!
Exactly.Shameful Healthcare and budget overspending.
Airport crop duster redesign over inflated by nearly a Billion! Unaccounted for cash.
“Studies, Reports and Consultants” raking millions annually. None of those big titles COs etc have any sense??
MPs give themselves all family Health and Pension for LIFE!!
All MPs should have back their unconscionable SALARY INCREASES as soon as the were elected and gave this not themselves!!
All avarice and greed for decades! Public and Private sectors alike.
CINICO so bad that the HSA staff use a PRIVate Insurance Provider.
No means tests for millionaire citizens who are still being given student scholarships and lifetime free medicals etc.
Overseas contracted civil servant families all given FREE Medical Coverage and education.
These all can well afford it!
Kurt, Mac, Roy et al..don’t think we forgot about your broken promises also years back to “give back” your own massive salary increases self awarded back then.
Poor People suffering.
That includes all the former Middle Class. all peasants we are now, awaiting UBI system.
Almost Zero public health education or prevention activities.
Poor people foods=sugar oil salt.
‘Starvation Wages’ defined by government = no doctor visits.
Health Ins plans worth schik.
so what did you expect??!
In other countries we pay towards our healthcare, a small monthly ammount and its there when we need it. Why tell me please, does it have to be free here, every cinoco member should pay 100 ci per month towards their cinoco and something set up for spouse and kids too sorry,
Civil servants should pay it ill go first
Who told you civil servents it’s free. Employer offer all these to employ people.
Private people rob you by under pay, no benefits, use all the loop holes in the law, how many of you were send home with out paying a single penny during pandemic…
Bargain with private employers than blaming civil servents…
If govt cut all these from civil servents… then the private even cut furthur
Thanks, 10:18, could you try that again in English please?
Healthcare here will never be right or affordable. Why? People run hospital with a blister or spelk for bags of meds . Ive never seen meds given out like here they like smarties
It need to welcome international Healthcare companies. They do offer much better coverage than the local insurance company which they are rip off!
You won’t convince me that at least part of this problem doesn’t arise from HSA incompetence – they chased me for years for a surgical bill following a procedure pre-approved by my insurer – HSA failed to submit their claim to my insurer within the required time frame. They sent me a bill a couple of years later and tried very hard to blame me for their error – to the point that I was harassed by their collection people who told completely blatant lies. I stood my ground and refused to pay, but someone ultimately had to pay for that mistake.
Doctors Hospital has a history of doing the same thing.
HSA didn’t collect it from insurance and you haven’t paid, then expense was down, not up…
Happened to me as well. They started billing me for the covered procedure 2yrs after the fact. I also refused. Ended up having a meeting with someone to explain why I wasn’t going to pay.
I didn’t pay and that is all.
Does anyone today buy a flight ticket price-unknown?
What if we change the order of health care provision from book>service>price>pay to price>book>service>pay?
Easy access upfront to approximate price of a visit, and a price/benefit talk during a visit – before any proposed tests, treatments or medications – would help us all control costs.
This country will turn into welfare state before the end of this PACT term. Why will Health City providing excellent health care are we sending people overseas in droves. Cayman’s refereeing doctors know the answer to that $$$. STOP the nonsense.
When CINICO was initially set up it was supposed to eventually become what its’ name implies. CAYMAN ISLANDS NATIONAL INSURANCE COMPANY”.Wonder why it is taking so long?
Nonsense, if writing healthcare coverage was so profitable, why then do firms keep leaving the market? Generali just exited.
We have a small market with a lot of people that are not healthy and high risk.
Need to allow Cayman employers and groups to go offshore for coverage by larger insurers with bigger pools.
I know of lot of people who buy the SHIT plan, sorry SHIC plan and then go offshore for supplementary coverage.
This is what we get by borrowing the American model for a healthcare industry. We built something focused on profit instead of service.
If we had copied the NHS model there wouldn’t be for profit companies upcharging on all our bills so a vanishingly small number rich people can get even richer.
The health insurance pie is simply broken down into too many slices. Why not treat the entire country (private & public sectors) as a single company?
Put the entire block of business out to tender.
Use CINICO to just administer the business and interface with the winning provider.
Every few years the tender could be redone, since with CINICO in the center, there should not be any disruption to the users.
Unusually for this forum, that seems to be a good idea. I wonder why it won’t work ? Ah yes, cutting out most of the middle men who would skim off the top.
Same for pensions.
Too many private operators in medicine which is a disaster for billing… All blame HSA but when billing comes blame private.
Wait when you open up cinico insurance to private, these cost will tripple easily in coming years..
What do we honestly expect when we add all these indigents and dependents and their cousins through this immigration debacle to our medical programs burdening down the entire system only surprise is that it has not gone totally bankrupt yet.
Correct- when immigration is broken, healthcare/coverage/insurance will be break too.
Why do MPs receive lifetime pensions after “working” 2 terms – this is absurd and needs to be changed!!!!
We did not vote for this nonsense.
Now I understand why the opposition abstained from voting for this mess!!!
Hey donut ya go sweetening up no ppm. This issue of health insurance was as big when they were in power and what did they do absolutely farkin nuting. So please this abstaining ploy is only because they stop ding certain other things and they can’t get the word outs their psyche. I want to ride my bicycle I want to ride my bike who made dat song again?
It was Queen, not that it matters to this conversation.
Agree with your point of view.
Get help please. You almost make sense.
open a govt hospital where all licensed medical professionals must work 4 weeks a year no charge to be able to maintain a license to operate in their profession elsewhere . this hospital is for everyone primarily for those without insurance
This topic has long been on my mind.
The Government or Health Commission need to regulate the Health Insurance company’s and stop them from charging exorbitantly ridiculous premiums for health coverage. Currently only the SHIC health plans are regulated i.e., cannot increase annually however there is no such regulation on premium health plans and so they can increase their premiums from year to year. Right now, premiums for BritCay insurance are approx. CI$900 for singles, CI$1700 for employee and child/ren (or employee and spouse) and CI$2700 for a family (depending on the number of employees in your company).
This has caused some companies to seek coverage from an international health insurance provider to provide a similar if not better premium plan at literally half the cost of the local premiums and include a SHIC plan for compliance (still at less than the local premium plan rates).
The only problem with this is that the local medical, dental and optical service providers won’t accept the Intl insurance because they aren’t obligated or regulated to, and so you have to pay IN FULL upfront and then claim back on your portal (at least you get a full 100% refund), but in this day and age and the ridiculously rising cost of medical services – who has this money to come out of pocket even for a shot time?
The CI Government and/or the Health Insurance Commission NEED to regulate the local Health Insurance plans seriously, OR obligate local medical providers to accept international plans in order to create competition for the local health insurance providers to regulate their prices.
If all local medical, dental and optical services providers were mandated to accept insurance no matter where from, and premiums were regulated – these bills wouldn’t exist because everyone would be covered.
Something serious needs to be done, and quickly!
Totally agree with you but regrettably protectionist laws enable monopolies and fair competition to drive up standards and drive down prices is the last thing they seem to want.
Perfectly said. My wife and me pay about $2000/month for health care. The health care company (not BritCay) keeps raising the rates as we grow older and will eventually price us into the zone where we are CINICO indigent.
Why? We’ve paid into this company for more than 35 years. It is past time for CIG to do the right thing and nationalise CINICO, create a broader base of insured, decrease the costs for everyone, maybe even build a hospital or two. People NEED real and effective health care.
OR, should our duties pay for millions of dollars in sand to be put on rich people’s beaches, for whom said rich people are responsible for the loss of their sand?
There exists a sharp disconnect between the needs of the people of the country and the government’s goals. Good Lord, give us a leader who represents the people. Thank you, Amen.
The health commission as about as useful as an ash tray on a motorcycle
Or a Cayman Islands Parliamentarian.
One small detail. The overseas insurers aren’t regulated by Cayman laws, nor do they have to comply with said laws. They have no obligation to honour a claim coming from local medical, dental, and optical providers. Remember those providers have bills to pay and families to feed also….
I do know they ARE obligated to honour claims from ‘members of the plan’ IF it is an international worldwide coverage plan, and as long as the service is within the said plan and plan cover limits. This isn’t any different from the local plans, the difference being they don’t do the direct processing and figure out your portion like the local plans do which is either why you pay up front and claim back unless you have a local provider willing to accept and figure it out later (knowing what is covered which is practically everything).
I know of companies with international premium health, dental and vision plan as well as a local SHIC plan for all employees, and the international provider has even modified its requirements to mimic those of the local processes to help providers in feeling comfortable to accept and work with them.
Employee claims are successfully received within 5-7 days and the same for the medical, dental and vision providers (those willing to accept), and the cover is more extensive, and the cover limits are greater than the premium plans on-Island.
They are slowly building a local network of providers willing to accept, it just the coming out of pocket for the providers who aren’t willing to work with the plan. And I daresay this is out of fear of the unknown.
Worldwide International plans will obliterate local plans if given the chance…
I’ve been requesting free or affordable community exercise classes and weight management assistance in our island-wide community centres for years now. The government says there is no demand for this service.
Seriously? How much would it cost to employ a couple of nutrician and exercise professionals to travel the island running classes for the youth, the seniors, the underemployed, and those who would enjoy the exercise and the social aspects of getting out of the house.
We could have dance, pool fitness, yoga, stretch classes – all sorts of things. And all provided as preventative health care by the government. A real boost to physical and mental health for us all.
Our MLAs set a horrible example for the health of the nation. Just because they don’t want to get off their fat backsides doesn’t mean the rest of the population aren’t concerned about their health and fitness.
Going for a walk or a run is free.
Agreed but organised activities are much more likely to be participated in.
especislly if they are catered by Wellys l, island Taste or Mango tree
Too hot and humid and not safe.
wow
This is because the Law is not enforced. And because the law enforced. And because the law is not enforced. And because some of those responsible for operating it do not understand their role. And because regulators are not doing their job.
Fix those 5 things, and we would be MUCH better off.
Oh to be a Civil Servant and live permanently in the land of milk and honey!.
something is clearly wrong with these government numbers yet AGAIN! its only about 27 thousand Caymanians in total. How can Government be spending 78 million on medical bills? They need an audit into all of this immediately it stinks.
Under $3000 per capita a year? That sounds surprisingly reasonable to me. To put it in context the UK NHS spends just over $4000 per capita.
You’re ignoring the fact that a lot of those 27,000 Caymanians, myself and my family included, have health insurance at exorbitant expense, so the per capita number is actually much much higher, I would reckon by a factor of 3 or 4.
My wife and I pay CI$2772 a MONTH …and there are many of us trapped in that net, so your $3000 a year is nonsense.
??? I pay $166 a month. Maybe shop around?
That’s SHIC at that premium level of $166/mth, you don’t get much under SHIC and that level doesn’t include dental or vision either.
That’s the entire population of Caymanians. And unlike the UK, we have a private healthcare system, where employers and individuals pay. The government is only meant to be covering the tab of the indigent Caymanians and the seafarers etc (or realistically their descendants – quite why the latter is another question). If that rule is actually being applied, given not all the unemployed and indigent can be sick, the cost per individual case is astronomical.
Which rather make you think that what is in fact happening is that everyone who claims to be indigent Caymanian is receiving free medical care, irrespective of whether they are, or that unnecessary cover is being provided, or that no care is taken with ensuring the care is provided at the lowest available cost and there is complete lack of discipline in sending people off to the States. Or some combination.
9.56am You forgot the 35000 Jamaicans feeding at our trough.
Who are not meant to qualify. So what is the issue here – the cost of the treatment, or the failure to apply safeguards and checks on who is receiving it.
Much of this largesse is no doubt linked to protecting votes I have no doubt.
The CS should make some contribution, plus means testing. 2 significant actions that would help to address the problem. Both are politically unattractive to most.
How expensive is the means testing?
All the time spent making applications. Hiring people to review and reject them according to arbitrary criteria. Investigating claims of dubious nature. These costs grow very quickly and drastically reduce the number of people who can be helped.
Means testing is often more expensive than the program itself.
We shouldn’t let the candle cost more than the funeral.
Everyone is focused on treatments, not a word about prevention.
CNS: The premier specifically mentioned prevention in this article, noting that it was a focus of the HSA.
@CNS one look at the current government and a majority of the civil service shows that is obviously not the truth.
CNS: Words matter. My note was to counter the claim that there was not one word about preventative healthcare measures, which was clearly a result of sloppy reading. How successful those measures are is another discussion.
This was understood. The was sarcasm based on the fitness levels of the existing government/civil service.
Biggest robbery of the 21st century and no one can do anything about it. Health insurance companies decide if you live or die. If you are over 65 they are not interested in preserving your life.
Saunders talks about expanding CINICO which is an avenue but why doesn’t he or any other MP say what Marco Archer had the balls to say? If civil servants had to contribute to their premiums then that would help cover the indigents.
I agree with the Premier that preventative care helps but as long as health care is free to the uninsured etc. what motive is there?
If the indigents and uninsured where given alternative therapies and ordered to do so that might help. If you are pre-diabetic rather than popping pills but them on a diet that could delay the disease and help with outcomes. I find too many are just looking a quick fix too.
Almost 1,000 foreign civil servants and all their families at the government trough, without limitation, for eternity. Amazing. It is going to bankrupt us. We are at the edge even with the economy booming. What happens when it falters?
bankruptcy is on it’s way anyway. still a few years off but drifting on the horizon for sure due to total inept mismanagement of public funds during the boom times.
So, 11:23, when we hire “foreign civil servants” to do jobs we need…teachers, police officers, prison officers….what do we do about their need for health care benefits? Tell them they don’t have any, they’re foreigners “at the government trough” but come anyway, life is wonderful in Cayman??
9.23pm Let them pay at least 30% of the premium and stop hiring those with children.
Instead of paying for medical services why don’t they pay for insurance?
Seriously? What does an insurance company in the middle bring besides taking a cut for profit? If anything insurance companies should be pushed out whereever possible.
how are those budget cuts coming along wayne?????
Still saving up for that $100million new prison…be sure to put aside millions for the foreign consultants too.
Budget cuts my a$$, stop this dollar bleed NOW Wayne.
Money needed for better .
north american health care model is recipe for financial disaster for the people and governments….every body except the health care providers themselves and the scam insurance companies…
You don’t follow the North American model.
my health insurance and healthcare model is identical to when I worked in the US. Even the same company!
You used BritCay, CayFirst, Sagicor, Carib Insurance, Britam, or BAF in the U.S.? Baloney.
There are two very different models of healthcare in North America! Assume you meant the US model.
nothing wrong with helping the needy as long as they really are needy and not sitting on a millon dollars of family land!.
said it before…all handouts must be accompanied by means testing.
I know of a few retired civil servants who could well afford their own health care but continue to leech off the system … just because they can.
And if they marry after they retire, their little expat partner gets free medical too!!!!
That’s what the seamen are doing with all these little Filipina girls 1:02
Generally speaking, means testing, and establishing the bureaucracy to run it, is more expensive than simply handing out the benefit to all who need it.
We have both – massive bureaucracy, and no discipline in who qualifies and what treatment is paid for (not least since many of those in the bureaucracy are the ones benefitting.
cayman welfare state is growing day by day…..soon they will just be cutting weekly cheques because you are a caymanian.
however this will spell economic doom for cayman generally and everyone will sink…..but current mla’s don’t care cos they still get their paycheck and with two terms they have won the national lottery for life with their life time pensions.
This comment gets right to the heart of the problem – buying votes for life time pensions. This is the epitome of short-term decision making gone awry.