HSA hiring freeze is a red flag; the system is cracking
Mira Sol Cay writes: Healthcare has changed. People are not just waiting to get sick; they are seeking prevention, flexibility, and continuity of care. Cayman’s healthcare system, public and private, is struggling to keep up. The Cayman Islands Health Services (HSA), with the right support, could lead that evolution, but only if it is allowed to complete fairly, attract talent and operate with the autonomy and resources it needs.
For years, governments have watched the healthcare landscape shift without keeping pace. Private clinics expanded while insurance providers began steering patients into increasingly exclusive networks — often away from the HSA. Those with premium coverage enjoy shorter wait times and choice. The rest are left navigating an overstretched, undervalued public system.
But the strain isn’t isolated to the public sector. Health City, one of the country’s largest private providers, has increasingly focused on integrated, preventative care. That forward-looking approach reflects changing patient needs, but it also benefits from concessions and strategic planning advantages not equally available to most other providers, public or private.
Meanwhile, Doctors Hospital, despite delivering excellent care, has had to pursue legal action just to gain fair access to public insurance reimbursement. Emergency rooms are overflowing. Specialists are overbooked. Bed space is limited across the board. Whether in a government facility or a private one, the cracks are widening — and patients are the ones falling through.
This isn’t a call to dismantle the private sector. Cayman can and should support a blended system where both public and private providers thrive. But that requires fair regulation, transparent governance and policies that put patient well-being above profit margins.
Instead, we’re heading in the wrong direction. In 2023, the Office of the Auditor General reported an $82.8 million deficit at the HSA, the largest among all statutory authorities. Seven of 21 government companies ended that year in the red. The Public Authorities Act now mandates that HSA salaries align with civil service pay grades, yet failed to increase funding to offset that mandate. National debt has doubled since 2021, and healthcare liabilities now exceed CI$2.4 billion.
The HSA’s 2024 report shows patient volumes in some departments up by 18%, but staffing levels flat. That strain is unsustainable. Staff burnout is real. Digital systems are lagging. Access to care is increasingly inconsistent across districts.
Even the Ombudsman has had to intervene, confirming that confusion around referrals and coverage has led to patient complaints and required regulatory clarification. These are not isolated issues. They reflect a fragmented, under-regulated ecosystem.
The hiring freeze isn’t just a staffing issue; it’s a red flag. It signals that the public health system we have relied on for generations is dangerously close to stagnation. But the private sector isn’t immune either. When healthcare becomes a privilege rather than a public right, everyone loses.
If we could reimagine healthcare as a public good and not a political liability, we would have a system designed to serve everyone, not just those who can afford to bypass it. If we could build policy around people, not profit, we would protect fairness, quality, and access across all providers.
Cayman deserves better. This isn’t about blame. It’s about balance. The system is cracking. Will anyone step up before it collapses?
- Fascinated
- Happy
- Sad
- Angry
- Bored
- Afraid
Category: Health, Medical Health, Viewpoint
The problem is not healthcare. The problem is mismanagement. People seem to think it’s because of a lack of funding and people going else where.
It is anything but that! The HSA is led by a bunch of people who are holding it back. If you speak to people who work there, you will hear of the corruption and bad behaviours that are normal . This has been the way for many years. The Government are asking all the right questions now. How is it that a body that can afford to hire all the highest qualified staff from all over the world is unable to retain staff? One of the highest paid healthcare sectors in the world. People come and go like tomorrow owes you nothing.
People in Cayman are going elsewhere because they do not feel they are getting good value for money.
Health city offer more patient centred care, making you feel like you are being looked after.
What a load of complete waffle. Reads like a language model.
Why are Caymanian doctors not returning home? HSA board have you considered this question? Does hiring freeze mean they can no longer return home even if they wanted to?
“…they are seeking prevention…”
from a hospital??
I know CNS will not publish this opinion XXX.
CNS: I would have published it if you hadn’t started it like that. Try again.
CNS why does this trigger you? It’s giving CMR.
CNS: Because people will get the idea that I’m more likely to approve a comment if they try to threaten or intimidate us or believe that it’s been published because of some weird reverse psychology (“I know you won’t publish this, CNS…”, or “I dare you to publish this…”). Then the comments will become full of this unnecessary blather, which is not only annoying but is also dull – for readers as well as for me.
Well said CNS.
Many thanks, CNS. The passive-aggressive “You won’t…” crap is noticeably absent here compared to other fora.
Well if you know then why send it, silly billy! Your trick didn’t work and you got what you wanted LOL
Cayman has no money, and can’t afford to give people free healthcare!
See https://caymannewsservice.com/2025/06/anglin-confirms-april-deficit-and-growing-spending
Can we please just grow up and accept this, and focus on giving our children the best possible start in life, rather than drowning them in more debt!
That’s OK for you to say until you or your kid becomes ill and finds that expensive insurance you have denies almost all the medical care you need.
Then what do you do?
Not everyone is lucky enough to have tens of thousands of dollars put by for medical expenses.
Sadly, if I or my kids become ill and find that expensive insurance we have denies almost all the medical care we need, IT REMAINS THE CASE THAT:
“Cayman has no money, and can’t afford to give people free healthcare!”
I’m trying not to be rude, but to get the point across politely and concisely. There is no money. There is no low-hanging fruit that won’t inflict long-term damage if we try to raid it for funds.
It’s OK for expats: while some of them will hang around forever with PR/Status, most will go home. They don’t care if Cayman bankrupts itself. It’s not their kids who will suffer.
I’m respectfully suggesting that we raise our eyes, and look at the long term perspective. Previous politicians lied to us. We can’t fix that, but we can start being honest now. For our kids’ sake.
With respect, this is utopian nonsense:
“If we could reimagine healthcare as a public good and not a political liability, we would have a system designed to serve everyone, not just those who can afford to bypass it. If we could build policy around people, not profit, we would protect fairness, quality, and access across all providers.
Anyone with even a junior high school economic education would robustly reject the claim that healthcare should be reimagined as a “public good” and removed from the realm of profit. Healthcare is not a public good in the economic sense: it is both excludable and rivalrous*. Labelling it a public good for happy-clappy, touchy-feely, wishy-washing, namby-pamby, tree-huggy emotional reasons does not make it one. Government provision introduces inefficiencies, distorts incentives, and – like with Medicare in Canada and the US, and the NHS in the UK – invariably leads to rationing (because eventually, to paraphrase Thatcher, government runs out of other people’s money).
Profit is the very mechanism by which markets respond to human needs. In a free market, providers must serve patients well or lose their business. In contrast, when the state runs healthcare, decisions are made by bureaucrats, not patients or doctors. This leads to long waits, reduced innovation, increasing costs and ultimately failure. If Cayman is determined to subsidise unproductive people (i.e. those who don’t earn enough to support themselves, and want to force other people to pay for them), the least worst option is limited, targeted financial support. There is never any good reason for dismantling the entire price-based allocation system that underpins efficiency and innovation. Far from being corrupted by profit, the healthcare sector, like any other, is most responsive and dynamic when governed by consumer choice and market forces.
People must live or die within their means. The further that a society moves away from that principle, the faster the economy collapse. Look at all the European welfare states, where their young people are emigrating because they are squandering €€€€€ on paying for old people. If you can’t afford it within your own family, you don’t deserve it. If you try to force other people to pay for it, they will leave. Italy, Greece, Argentina, and Venezuela are all great examples.
___
* Excludable means access can be restricted to paying users; rivalrous means one person’s use reduces availability for others — unlike true public goods like street lighting, healthcare involves limited, contested resources.
‘…because they are squandering €€€€€ on paying for old people.’
Some people are just ignorant and talk rubbish!
Thank you for your intelligent, articulate, and well-evidenced rebuttal. I recommend Basic Economics: A Common Sense Guide to the Economy, by Thomas Sowell: https://www.amazon.com/Basic-Economics-Thomas-Sowell-ebook/dp/B06XCH5NGZ. His other books are also excellent: https://www.amazon.com/stores/Thomas-Sowell/author/B00J5BK55K.
The main costs crippling welfare states are subsidising unproductive people. Sowell’s distinction between what he calls “producers” and “parasites” highlights a fundamental economic and social dichotomy. Producers create goods, services, and wealth through labor, innovation, and enterprise. Parasites, in contrast, consume the fruits of others’ labor without contributing equivalent value, usually leaching on redistributive systems. Societies that punish their producers through taxation and regulation while rewarding parasites through welfare benefits become unsustainable.
Welfare states distort incentives and undermine productivity. When governments transfer wealth from producers to non-producers, they discourage work, investment, and entrepreneurship, reducing overall economic growth. Welfare creates perverse incentives for individuals to remain dependent rather than being self-sufficient. Over time, the shrinking pool of productive citizens must shoulder an ever-increasing burden, leading to fiscal imbalances, higher deficits, and declining economic dynamism. Further, in an internet-connected world defined by increasing globalisation, it is extremely easy for many producers to decline to prop up such exploitative states.
The collapse of such systems is not ideological – it is an economic inevitability. No society can indefinitely penalise wealth creation while subsidising dependency. Post-WWII European welfare states exemplify this. They have not even survived one human lifetime before faltering under the strain of over-promised benefits and dwindling productivity. Economic reality, however unpalatable to left-wingers’ emotions, is asserting itself.
Cayman has, so far, been a net beneficiary of this because productive people have moved here from the US, Australia, Canada, and Europe. Those states’ collapsing welfare and redistribution mechanisms ought however to be a warning not to emulate them.
Once you have read Basic Economics, please get back to us with a substantive response.
Very welcome! Who is ‘us’ LOL When you have read Basic Life and Living, please do not get back to ‘us’ with a non substantive response as above.
“ Anyone with even a junior high school economic education would robustly reject the claim that healthcare should be reimagined as a “public good” and removed from the realm of profit. ”.
Really? I have a Masters in Economics rather than a junior high school education and can tell you that considering healthcare as a public good would be considered as a core objective by many great economists, including Nobel prize winners ( which Sowell, interesting though he may be, is not), and central to major schools of macroeconomic theory. My personal views were more free market and monetarist – like Sowell, I am a big Friedman fan- but even I, fairly right wing as economists go, wouldn’t consider suggesting something as fundamental to human life and well being should be entirely privatized with the inevitable exclusion of some from what is a basic human need. But then again, your comments on spending too much money on old people seem to demonstrate that your views on society are elitist at best and verging on Nietzschean. Let’s let the old and the poor fend for themselves and die is certainly economically efficient but not something most people would think was socially acceptable. Perhaps you should take your own advice and read more widely. Or grow a conscience and adopt some basic human values. But don’t ridicule people who don’t share the same values as you as being economically illiterate .
Thanks for your reply. I don’t know anywhere other than Singapore which has successfully implemented wide healthcare provision. All of the rest, to varying degrees, used rationing or service non-availability to save money. The most utopian schemes are failing fastest (Canada, UK, France, etc.).
Singapore’s approach is effectively that of Friedman/ the Chicago school: hand it to the markets, and ensure that incentives are aligned with desired outcomes.
Take the UK’s NHS as an example, because that’s where I used to work (as an expat, before becoming sick it). If you compare that to Singapore, the latter combines individual savings, controlled insurance, limited government subsidies, and regulated private provision to achieve lower costs, higher efficiency, and strong individual responsibility:
– Attitude towards free care and personal responsibility. Singapore explicitly rejected the NHS model, considering it overly generous and prone to misuse. Unlike the NHS, which provides healthcare free at the point of use funded by taxation, Singapore introduced nominal fees to foster individual responsibility, recognising that free care leads to waste.
– Cost and efficiency. The NHS spends about 10% of UK GDP; Singapore achieves superior \outcomes (such as higher life expectancy and lower infant mortality) at just 4% of GDP. This is due to Singapore’s encouragement of personal responsibility.
– Funding mechanisms. Unlike the tax-funded NHS, Singapore mandates MediSave accounts. Thus, Singaporeans directly see and control their healthcare spending, a significant contrast to the NHS’s taxpayer-funded approach.
– Insurance and welfare. MediShield insurance is compulsory, paid for by individuals, whereas the NHS [purports to] covers a broad spectrum of care comprehensively.
– Public vs private. Singapore blends public and private healthcare provision. About 80% of Singapore’s secondary healthcare is public, but it encourages competition and transparency in pricing, using market principles.
– Patient choice and incentives. The NHS does not incentivise patients to limit their healthcare demands, as treatments are free at the point of use. Singapore, in contrast, incentivises them through direct out-of-pocket payments, price transparency, and hospital subsidies tiered by income and hospital room type, intentionally making patients mindful of costs.
I was very tempted to work in Singapore: it’s easier to get home to Australia, but I thought I’d spend a few years in Cayman first.
Fantastic reply, 12:34 pm. The OP talks about a fundamental human need in such a cold hearted manner, it made me cringe to think some people actually think like that. Spending too much money on old people??? The same people who probable worked their whole life and surely deserve to be taken care of?
“If you can’t afford it within your own family, you don’t deserve it.” What a horrible, horrible thing to say.
I only hope that the majority of humanity embraces basic values instead of his selfish “me, myself and I” attitude.
I agree with all of this. My issue with Cayman healthcare however is the middleman. There has to be a more efficient way of administering private healthcare than through multiple for profit insurance company skimming away, adding no value, inbetween patient and provider. (Same goes for pensions in Cayman)
This op ed is sadly quite uninformed in my opinion.
When has anyone, on earth, ever…said that they think the government is the best entity to carry out XYZ? With the exception of natural disasters and war, pretty much never.
Countries with government run insurance programs have their issues. Countries with government run health care practices have plenty more.
The author says it in their own words, effectively “Health City is taking the right approach”. HSA is nowhere near that. It boggles my mind that this country “requires” all individuals to have health insurance, yet spends tens of millions of dollars each year caring for the uninsured. WTF? How does that happen?
People need to learn how to be healthy. Stop eating fried and fast food. Steer clear of the ginger beer and lucozade for every meal. Don’t smoke. Limit alcohol. Use protection during sex. DRIVE SLOWER AND MORE CAREFULLY.
As long as people keep treating their bodies like dumping grounds and driving like there is no tomorrow, there is no health care system on earth that will manage it. It’s just slow and steady suicide.
You lost me on “People need to learn how to be healthy.”
You did not mention, because you and others have no idea, what really is behind good health… repeating the same dogmas.
Use your critical thinking skills and may be you”ll arrive to a conclusion what “ingredients” are necessary for good health. A hint: You don’t get those ingredients through your mouth and digestive system.
Ooh! Mr Mysterious! Sexy! Share your secrets – “what really is behind good health”? What “one secret fact do doctors HATE IT when you learn about ©™©™©™©™”?”
Or, is it actually as simple as:
1. Eat in moderation, mainly vegetables.
2. Don’t smoke, drink alcohol, eat sugar, or use drugs.
3. Exercise daily.
4. Sleep 8 hrs/night.
It can’t be the latter can it, because that would prevent the bottom feeders from blaming everyone else for their own inferior life choices, and the concomitant inferior life outcomes. You can’t grift $$$ from taxpayers if it’s your fault!
I’d always believed that diet was paramount for health, but something deeper emerged – mitochondria! our cellular engine! They need sunlight to function and darkness to repair.
I realized that merely eating healthily or taking supplements wouldn’t fix malfunctioning mitochondria.
The solution? Aligning with nature’s rhythm: sunlight during the day and darkness at night.
Getting sunlight was free and simple.
But avoiding light at night in our electrically-lit world?
A serious challenge.
Research showed high-energy blue light disrupted the body’s circadian rhythm the most.
A unique photoreceptor, melanopsin, linked directly to our body’s master clock, affecting sleep, brain function, and metabolism.
Prolonged exposure to artificial light, I discovered, affected my health significantly.
( Dr.Jack Kruse, Reversing Disease For Optimal Health site)
Each and every article is supported by links to numerous studies from all over the world. You don’t have to be versed in biophysics to understand, but some knowledge of biology and physics would help. P.S. no need to be so cocky. You don’t know what you don’t know.
my guy, they’re not dogmas. We know sugar, fats, fast food, cigarettes, alcohol, and driving like a maniac are bad for you.
What magical “ingredients” would you like to educate us all about?
How about those who exercise, don’t eat sugar and junk food, don’t smokes and get cancer before they turn 50? There is an epidemic of Turbo-cancers. My dear friend, 35, died from colon cancer, it was stage 4 when diagnosed. Her little girl is only 6. I am a post-op nurse in a hospital. 5 out of 10 surgeries are colon cancer stage 4 surgeries. Yet, your list doesn’t include DIY stool tests such as FIT or gFOBT or Cologuard. They are affordable and require no visit to a doctor. The sensitivity of these tests is over 90%. But I bet you have no idea. You only talk about sugar and smoking.
Caught early colon cancer is treatable. No need for an immediate colonoscopy. Stool tests are so sophisticated today, and affordable ( starting $30), that skipping it is stupid. I’d recommend every 6mo, for everyone who is over 20. Turbo-cancer is real.
This article was written by ChatGPT, and it shows. See: https://medium.com/@jordan_gibbs/spot-the-bot-why-chatgpts-style-is-so-obvious-e27c6afe1595
Anyone who has experience of using ChatGPT recognises the distinctive prose and punctuation. There is a specific rhythm to the way sentences and paragraphs are constructed. There are familiar tells, from em dashes to “it’s not just x, it’s y.””
Please stop: it’s dreadful, and renders one’s substantive arguments almost worthless, because reading them feels like being lectured by a bot.
So many books today are written by AI …pure garbage that makes no sense. And people can’t distinguish it from a book written by a living and breathing human.
Government is pouring too much funding into HSA to the point where it is causing a deficit. Unfortunately, you are right about one thing:HSA is lagging on preventative care which would be able to bring costs down.
HSA can’t fix people’s poor life choices:
– Don’t smoke
– Don’t drink
– Don’t eat sugar
– Exercise daily
– Sleep 8 hours/night
If you reward such people by paying for their healthcare, you are simply encouraging them to do more of the same.
Prevention is better but some of the healthiest people get sick too!
Babies born with congenital conditions did not smoke, drink, ate sugar…just saying…
Great, that’s 2% of the health budget that is reasonable to spend.
Let’s focus on the 98% which very much is people’s own fault, because that’s both the overwhelming majority, and easily solvable: stop rewarding them by paying for their healthcare.
Correct. The health problems of almost all fat people are driven entirely by their lifestyle. It’s not cuts or bruises or bacteria or a fungus or a virus or some tumour or hereditary disorder that’s the source of their size, but the way they’re choosing to live. The simple solution is: eat less (mainly vegetables), and cut out sugar almost in its entirety. Even exercising doesn’t really help: you can’t outrun a bad diet.
This is challenging in Cayman because of the cost of healthy food. CIG is complicit in failing to incentivise market forces to provide inexpensive healthy vegetables. At the very least, import tax on vegetables could be removed. What would also be worthwhile would be an external independent market competition review* into whether the local grocery chains have a de facto monopoly, and if so options to break it (*with the report published, not covered-up, for a change).
That said, even with the cost of vegetables, the main issue remains eating rubbish. Calling obesity a disease is an attempt to (a) misrepresent where responsibility lies – the hand that unwraps the burger controls the waistline; and (b) generate profits for greedy drug corporations for whom recent “disease” rhetoric offers a commercial opportunity.
See:
1. “People with obesity can cure themselves. That’s true in literally every case of obesity. You can lock someone in a room and feed them 1,000 calories of fruit every day, and they will be cured with one-hundred percent certainty. All you have to do is eat a healthy diet, and you’re cured. You can’t say the same for everyone with asthma or diabetes (at least not Type 1 diabetes). And if obesity is a disease, you’d need to explain why almost nobody in the country had this “disease” in the 1930s. And why nobody in Ethiopia has it today.” From: https://archive.is/20240321204438/https://www.dailywire.com/news/virtually-every-medical-expert-is-lying-to-you-about-obesity-heres-the-proof#selection-1635.8-1635.599
2. The misrepresentation of obesity as a disease was covered here: https://www.youtube.com/watch?v=3fNuv3kgzRo. It argues compellingly that the medical community’s recent classification of obesity as a disease undermines personal accountability and emphasises pharmaceutical solutions, ignoring lifestyle factors. The significant rise in obesity rates contrasts with historical data, suggesting societal and environmental influences rather than a medical condition. The AMA’s decision to label obesity as a disease appears driven by financial gain, indicating a conflict between public health and profit. Medical professionals often discourage questioning the obesity-disease narrative, which limits open discussion on alternative solutions like diet and exercise. The absence of unique symptoms for obesity challenges the scientific basis for its classification as a disease, revealing a gap (or, rather, a profound chasm) in the rationale for such claims. The rise of weight-loss drugs as primary treatments in recent years tracked the trend to call obesity a disease, and reflects a broader trend of prioritising $$$$ for medication over personal choices.
Your turn come. Then what will you say?