Time to tackle health insurance problems, say MPs
(CNS): The unsustainable cost of the Cayman Islands Government’s growing healthcare bills must be tackled, MPs argued during a Finance Committee meeting on Friday. It remains to be seen how it will get to grips with the under- and uninsured, the pressure on the hospital from a growing population, the soaring costs of medication and unhealthy lifestyle choices, but it was clear during the meeting that the status quo is unaffordable for everyone.
At the meeting, MPs added nearly $29 million to the budget for providing primary and tertiary medical care, both locally and overseas, to indigents, seafarers and veterans, as the original budget allocation of $26.4 million for these expenses has already been spent in the first quarter of the year. Furthermore, the government expects to return in September to ask Finance Committee for another similar amount.
As members asked questions about the spending, the provision of and access to healthcare in general and the decades-long problem of rising costs, Chris Saunders (BTW) once again raised the issue of national insurance, given that the current inadequate system continues to fail everyone involved.
Saunders warned that the private sector health insurance providers are currently making a profit, but this is decreasing each year, and they will eventually start to pull out of this jurisdiction, given Cayman’s ageing population. He said this was a “scary” situation since insurance companies are not interested in providing insurance for the sick and elderly.
“At what point are we going to see these foreign insurance companies pull out, leaving an ageing population with pre-existing conditions?” he asked. “We need to start thinking seriously about a national insurance solution as the private sector will pull out and leave our people when they can no longer make a profit, and the trend is that they are making less and less money on an ageing population.”
Saunders said it wasn’t a matter of if but when, and that this is not a political issue but a national priority, as he suggested it should be tackled through a bipartisan approach.
In his role as chair of Finance Committee, Finance Minister Rolston Anglin said Saunders’ point was well taken, as spending on medical care for elderly Caymanians, both locally and overseas, was increasing significantly year on year. The tab was around $82 million in 2024, and the estimate for this year is around $84 million. Anglin noted that, as people retire and are no longer covered by private sector insurance providers, they are coming to the government.
CINICO, the government insurance company, falls under Anglin’s Ministry of Finance, and he said the whole problem of healthcare cover for Cayman’s elderly and indigent was under review. He agreed that the “right way to go” was for all members of the House to be engaged in finding solutions and determining what the future of healthcare and health insurance will look like in Cayman.
Health Minister Kathy-Ebanks Wilks said the pressure on the hospital, fuelled by a growing population, was a problem that has not attracted as much attention as cost issues. “We have a lot more people in the country,” she noted. She said there hadn’t been “a whole lot of talk” about this, but they need to find an interim solution, which may mean using private sector facilities to deliver the Health Service Authority’s services.
However, costs dominated the discussion, and the finance and health ministers as well as Premier André Ebanks committed to more transparent budgeting for these allocations, setting expectations that when the new coalition government rolls out its budget for 2026 and 2027, it will be allocating close to $85 million for healthcare for elderly and indigent Caymanians, including seafarers, veterans and their wives.
While the number of seamen and veterans that the government covers is obviously declining each year, the elderly population in general is growing. Most Caymanians retiring from the private sector lose their existing cover almost immediately. Where they can find insurance companies willing to offer them policies, most are more than their monthly pension payments, creating an impossible situation.
As insurance cover is mandatory in Cayman, pensioners are going to CINICO for cover, but in many cases, they still can’t afford the premiums. As a result, the government is picking up the tab for all but the wealthiest local retirees’ medical bills. This has created a situation where the concept of a national insurance solution starts to look obvious.
But until now, successive governments have been reluctant to take on private sector insurance companies. However, as their profits decline, it is becoming easier for CINICO to take on more clients and eventually create a national insurance system that can then benefit from the payments of the younger, healthier, transient workers, which would spread the load and take the pressure off the public purse.
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Category: Government Finance, Health, Health Insurance, Politics
Socialised healthcare disastrously causes high-tax, low-productivity doom spirals as productive people emigrate, go-part time, decline promotion, or retire early, to avoid subsidising other people’s poor life choices.
Many European healthcare systems appeared superficially successful until recently. Sadly however, their economies relied on US defence spending, Russian cheap energy, and both cheap products from and a large market to sell to in China. The US is now unwilling to subsidise European welfare states, and Russia and China are now hostile.
The most successful and sustainable healthcare system is Singapore’s, where people are forced to save their own money throughout their working lives into ring-fenced funds. It minimises taxation-funded spending, while maximising people’s exposure to what treatments actually cost. The results are extremely impressive. By forcing citizens to save and manage their own spending, the system frees up money to spend on goods besides health care.
Video overview: https://youtu.be/sKjHvpiHk3s
– MediSave. Forces people to save into mandatory health-savings accounts (to which employers also contribute). Superficially like UK National Insurance contributions, but they belong to the individual rather than simply being seized for redistribution.
– MediShield. Government-run, single-payer catastrophic insurance. Requires co-payments and deductibles from patients, to incentivise self-discipline. Operates alongside private Integrated Shield Plans that individuals can purchase to enhance coverage.
– MediFund. A further safety net, for patients who can’t cover their bills. It does not explicitly punish individuals for fecklessness, but its means-testing, institutional discretion, and limited funding create structural disincentives for relying on it as a safety net or a backstop for preventable, lifestyle-related diseases.
when you go to a private clinic, God only knows how much they bill insurance company as patients are only told of copayment but not the total billing to insurance company, so premiums will increase
I will give you a piece of free advice from abroad. You have got too many doctors, too many hospitals and way too many admin people on that island. When they catch a patient they have to rob that patient blind just to survive. The rest you can figure out yourself.
Easy solutions all those dependents not even living here bilking the system overseas whilst Caymanians being told they cannot even get coverage needs to stop. This government needs to stop handing our rights to others As for this joker we call DG talking about the place will close down if they leave If we are not benefiting from our own system he right about that it needs to be shut down. When is he going to retire soon i hope.
Slightly off on a tangent, but we could also save a whole load of money by having preventative medicine education given more onus.
The sheer number of obese people here, including chunky kids, is an absolute disaster.
I guess the same is true for driving standards, too.
There isn’t a fat person in the world who doesn’t understand that they need to eat less.
Every single one of us has access to more knowledge in the palm of our hand than the ancient pharaohs could have dreamt of. We can simply ask Google or ChatGPT how to lose weight.
The hand that controls the fork controls the waistline. The answer isn’t “more education”, it’s cutting off fatties from any entitlement to healthcare.
HSA should do what they do by the side of the freeways in the US: have a ‘weighbridge’ at reception. If you’re overweight, your entitlement to healthcare ceases until you lose weight (or die).
That should be combined with a Korean-style ‘fattie gate’ system: https://www.reddit.com/r/Damnthatsinteresting/comments/1dduuhq/children_checking_how_fat_they_are_in_korea_using/
Link is to a picture, with different width gaps:
Top: how’s your health?
Bottom, from left to right:
– Danger!
– I am too thin
– I am slim
– I am average
– I am bouncy
– I’m thin in my imagination
– You shouldn’t be like this!
– You are an alien
Once people start hearing about friends and colleagues who were left to die because they were too stupid and too lazy to lose weight, the message will get through. Stop rewarding inferior people’s inferior life choices.
Best preventative medicine would be closing the fast foods on island, restricting alcohol and fixing the dump. Never going to happen
Interestingly, health insurance companies are continuously criticized for their premiums, but no one seems to question how much the doctors are billing or how frequently.
How many check the Explanation of Benefits to see what’s being charged, or the services that are being billed? Or ask the doctor or hospital for a fee list before seeking non-emergent treatment?
Our newest health minister needs to provide existing regulators with more staff to ensure laws are being upheld and the medical industry has robust medical standards. Insurers, brokers and medical practitioners must be held accountable.
Informative article in today’s Cayman Compass about the HSA board.
HSA board needs to be replaced. Always a bad idea for a former senior employee to be a director let alone chair the board. HSA chair needs to be immediately replaced by a Caymanian professional. [Dan Scott comes to mind]. Lack of experience being on boards seems to be the
reason the HSA chair is calling so many meeetings a week.
Any professional board member knows that the board only sets policy and management executes. CIMA board for example follows this.
The George Town people should be proud that whilst their elderly are having difficulties maintaining health insurance premiums your MP Kenny Bryan and cronies were busy building parks and aircraft hangers for the wealthy. This is so sad to read, no accountability, this criminal!
Well, one can go to Panama and other places in Central America and also Caribbean islands and get 60-70% less cost of medical, dental and eye exams for free and less then prescribed reading glasses for less then US.$50. Plus enjoy a 2week vacation with the rest of the rip off that these companies charge. I had a quadruple heart surgery ,gallbladder surgery within 2 days of each other. 2 years before that a mini-stroke.
The question is because of acid reflux which I thought was causing occasional discomfort in my chest I lost 50 pounds over a year and visiting with 3 doctors that I paid for here in Cayman from CI$150-600 per visit including tests. They discovered it simply by checking my blood? How did the other doctors miss it? My acid reflux specialist told me he would need to do a endoscopy to find out more information ($3600 CI) in a consultation that cost me CI$400?
Well I decided to get a second opinion and went to Panama where my private specialist charged me US$70 and told me I had to stay for an extra week because there were many patients going through the same thing. Well what a surprise I got when the doctor said we can using imagining instead of endoscopy? Really? yet really ,well doc how much is that going to cost he said see the cashier. She said US$130 . I quickly pulled out my debit card and went to a first class seafood restaurant and enjoyed a surf and turf of US$60 not including tip for my wife and I.
I went 4 times to Panama and the last time I found a Airbnb next to Hylton US$1200 for 2 weeks up in a 60 story building. I returned and did my teeth also and found pharmaceuticals 75% less than Cayman. Moral of my story don’t listen to the narrative of insurance companies or some doctors who are taking advantage seek a second opinion who haven’t forgotten their hippocratic oath. Enjoy Panama
Plenty of other “services” cheaper there too.
Why do Cayman folks love Panama for healthcare? Great doctors fix your heart – and great escorts make it race again.
CIG should create package holidays to provide both services – it would save a fortune!
I went to another Central America country and paid US$1000 for an MRI. Here they were charging me nearly CI$ 5,000.
Perhaps there are cost saving measures yet to be explored.
Maybe if CINICO were able to bargain on behalf of all the island’s insured people, it could drive down costs. If we could share resources between all insurers and present a united front to healthcare providers, it might work.
Additionally, such a system wouldn’t need as many administrators. We only need one CEO, one CFO, one set of board members etc. There could be significant cost savings there as well.
Yes we need not just the URC amounts that limits what the insurance pays out, but instead to actually limit what the doctors and hospitals charge us patients for their services.
I paid $195ky for a 5 min chat with a doctor to hand me my blood test results and tell me everything was fine.
$250 bloody USD for 5 minutes? My insurance only pays $120 max for consultant visits and then only 10 per year.
So now I eat ramen for the rest of the month while they all drive round in fancy cars back home to their mansions?
When the times comes I actually need medical care, despite an expensive insurance, I know I’ll lose all my savings.
Dwayne Jon Jon has this portfolio for 8 years and this is the end result of his incompetence. Bodden Towners almost made the change but they fell short. Its quite unbelievable he managed to get that many sane people to vote for his re-election
That’s because he had a lightweight fool running against him.
His upending is nigh, just like McBeater’s was.
How about collecting some of the amounts owed to the HSA to start.
Start by fixing HSA accounts.
And garbage fees and school fees and apron fees ….
I retired 10 years ago. I had very good private sector health insurance since it became mandatory until three months after my retirement. Since that time I have had to pay CINICO $501 per month. Most times the bloodworks done at the Bodden Town clinic has to be done over by the GT hospital at my expense. Please understand I am not blaming the techs at the clinic, I was told by a doctor it is because of the delay in getting it to the lab in GT. I do not know if this government is considering building a proper clinic in the Bodden Town area , if not they should. The current one is not fit for purpose. In fact the eastern districts could do well with a small well equipped hospital or perhaps they could team up with HealthCity to accommodate the patients in these areas if that would be less expensive. When CINICO was setup the plans were that eventually it would become what the name implies. Cayman Islands National Insurance Company. Every person working and abiding in Cayman should have had had health insurance coverage with CINICO. It must be now 30 something years too late! Healthcare, traffic, education, environment, landfill etc. etc. never got the attention that was needed and now everything is a mess. all the time the money was being wasted though??
CIG raises over a billion dollars a year, and then proceeds to waste most of it on kick-backs and boondongles.
There’s no such thing as free anything, much less free healthcare.
Demanding that CIG confiscate even more money from people, to create a welfare state, is doomed to kill the golden goose that has so far made Cayman for more prosperous than any other Caribbean island.
CIG needs to cut its spending dramatically, because the reality at the moment is that it has vast hidden ‘off balance sheet’ liabilities which it’s refusing to admit to – pensions and unaffordable promises about medical care are the two main ones.
Will this be yet another talk talk administration?
Looks like that ..at least so far.
GFCFC
Many thanks to MP Saunders for highlighting this issue.
Please get him to explain explicitly what he means by “national” health insurance. This term needs careful explanation.
We should really just be adding everyone to the NHS
The NHS:
1. Has been broken for many years (source: over 20 doctor friends, and personal experience); and
2. Is bankrupting the UK (source: see UK budgets, passim).
People need to live within their means. It sounds harsh, but it’s that or destroy Caymanian kids’ future with immense debt.
First place to start, expatriate civil servants should keep their full CINICO coverage, however there needs to be a contribution for their spouse and dependent children. If that does not put a dent in the bucket, then the same logic should be applied to every civil servant. Employees should be covered, however a contribution needs to be made for spousal and dependent coverage. In regards to the free coverage for life for retired civil servants and their spouse, thought needs to be given in removing that benefit for the spouse. None of these suggestions will be popular, however serious consideration needs to be given in order to reduce this health care liability issue.
Benefits must be stripped across the board – the entire farrago is unaffordable.
I find it unbelievable that if you get married after you retired the new civil servant spouse gets free health care! Any retired civil servants out there want to marry me? I’m Caymanian, now single (widowed) & worked in the financial services sector for 45 years . In good health & im told I’m personable & good looking (for my age LOL!).
I have pay 100% of my health insurance. It’s KYD 1000+ monthly. Marry me & I will give you $500 a month!
Male, female or undecided?
12.47pm We also need to stop providing free Healthcare to Status holders. When they applied one of the conditions was they could maintain themselves and their family. Yet every time I go to the HSA the waiting room is full of them and none paying.
When they became Caymanian they most likely were able to provide for themselves. We are all one medical issue away from bankruptcy, especially if you have the mandated insurance which covers basically nothing.
Well said. If they don’t like it, they can go home.
This should be an easy win: it will be popular with Caymanians (who are suffering because Mac’s status grant thirdworlders are bleeding Cayman dry) and expats will appreciate it too (because it’s their money being used to fund everything).
Make it happen, CIG!
We cannot change the contracted health arrangements existing for civil servants but we certainly can for new hires.They should pay for their own health insurance like everybody else in the real world (private sector).
I am happy to see that Cinico Coverage for the over 65s uncovered is being highlighted. Now can you put into effect for us to get coverage without hindrance. My widow’s mite pension cannot keep sustaining health insurance. To make it easier then why not let all pensioners, veterans and seamen be automatically get coverage. I am 66yrs old Govt pensioner uncovered by Cinico Insurance as I did not retire in Service. Majority of countries has coverage in place for their seniors including Jamaica. Action needed now.
“…why not let all pensioners, veterans and seamen be automatically get coverage?”
Because you can’t afford it. You can’t strip ever more money from other people to pay off voters – the people who the money is confiscated from get understandably annoyed.
Horse Crap!
It’s time to tackle all insurances in this Country.
You think Caymanians can’t afford homes? Add fire and flood insurance to that, and it doubles the cost of home ownership.
CIG is allowing the insurance companies to steal our money.
If this is true, and there’s a profitable market out there, why haven’t competitor insurance companies swooped in to undercut all the insurance companies who, you assert, are stealing your money?
No one seems to have an answer to this!
TROLL!
Thank you for your intelligent, logical, robust evidence-based rebuttal.
I now see the light. Caymanians are correct, after all: there *is* a vast international conspiracy by insurance firms to steal your money.
Are these conspirators in the room with us now?
Well said! Start your own insurance company, undercut all the thieving American ones, and you will kill many birds with one stone:
1. You will provide cheap insurance for everyone!
2. You will make money yourself, as a successful business-owner!
3. You will prove that Cayman can afford to pay for all the promises that previous politicians have made!
Good luck!!
You work in the insurance business for sure.
I wish!
According to the guy above, it sounds VERY profitable.
Why hasn’t he become an insurer, if it’s that easy?! 🧐
Agree. Now that we are old enough to need it, our (two of us) health insurance is more than $2000/month. Our retired income barely covers that. Not sustainable. How to choose between health care and bills? Both of us paid into the system all our lives, worked hard. They must call these the golden years because they cost so much.
Zzzz
No need for health insurance, the HSA can’t legally refuse you care.
Oh they absolutely do. I needed an outpatient surgery. They walked me to the cashier to pay for it before signing me in. If I didn’t pay I would not have had the care I needed.
I thought that HSA was obliged to pay for any Caymanian, hence why they are effectively bankrupt?
Why did they charge you?
As someone who has worked for the last 45 years and been in good health throughout with very little usage of health insurance. I now find myself unable to retire because the pension is impossible to live on and having to continue to work for health insurance. I am lucky, still fit and able to work, but why is it that we simply forget about those forced to retire due to ill health, unable to get or afford cover and rely on handouts. This should never be the case. People who have worked all their life should be able to retire in comfort and live out their remaining time with no worries about medical care. This is a problem created by the various governments who get a golden pension and healthcare for life. It is a case of making sure they are ok but not the people they represent.
– Doctors and nurses won’t work for free.
– Hospitals can’t operate for free.
– Drugs companies won’t provide drugs for free.
So every demand for “Free healthcare” is a demand that someone else has the money that THEY earned, for THEM and THEIR family confiscated from them for redistribution.
This has worked very well for Cayman in the past, because western welfare states’ punitive taxation systems caused people and assets to move to Cayman. We should be wary of emulating the same mistakes decades later.
Well thank you captain obvious, but please tell me where you read in the post it should be free?
Thanks for your question.
Chris Saunders is the Cayman equivalent of Bernie Sanders: an unapologetic de facto socialist. I make the following assumptions:
1. The current market for health insurance is efficient, i.e. there is active competition and prices are as low as they can be (if they could be lower, other companies would swoop in and take customers).
2. Saunders wants to replace this with [elements of] government provision, funded by taxpayers (largely financial services sector work permits and other fees).
3. This will be less efficient than the market – because government provision almost invariably is. It will therefore cost more.
4. Saunders doesn’t care, because he’s buying votes.
5. The services that Saunders proposes to provide will be either entirely, or in large part, “free”, because CIG will further abuse its taxation powers to fund them.
This will be disastrous, because it’s dealing with the symptom not the underlying problem: people must live or die within their means, at a ‘family unit’ level. If you can’t afford X, y, or Z, there is no sustainable economic model in which you can get X, Y, or Z.
That includes medical care. That sounds harsh, but it is accurate. Large countries like Canada (Medicare), UK (NHS), USA (Medicaid/Medicare/VA) are already failing. The danger for Cayman is that it is a tiny island which is extremely vulnerable to a highly mobile population in the financial services sector. Unlike Canada/UK/USA, if Cayman messes up, we could very rapidly become another Bermuda: there is immense competition from e.g. ADGM, Dubai and Singapore. Saunders is playing with fire.
What a sad, backwards way of thinking.
At least that person actually is thinking, rather than witlessly emoting.
You’ve failed to even attempt to address the points made.
Assuming you accept the (easily verifiably) premise that large countries like Canada (Medicare), UK (NHS), USA (Medicaid/Medicare/VA) are already failing, on what basis do you assert that Cayman – by contrast to those economic powerhouses – can suddenly magic up ‘free money’ to pay for gizzits demanded by the economically illiterate?
What’s your solution, Sherlock?
Tax the non-resident luxury property owners, foreign land bankers, etc, and stop giving duty concessions to ultra-wealthy foreign developers. Also, tax the churches and stop giving them concessions for their obvious money-laundering schemes. Implementing any single one of those would provide millions every year to fund healthcare for generational Caymanians.
Well said MP Saunders.
Remember Cayman does NOT have income tax. That’s what funds the medical costs in other countries.
What is this about veterans?
An 18 year-old in 1945 would now be 98 years old. They can’t realistically be any more living veterans.
Is this just yet another euphemism to provide a veneer of legitimacy for CIG to further tax expats to subsidise Caymanians’ poor life choices and unhealthy lifestyles?
Who else is gonna pay?
And yet here you are. I’m sure providing a service that a local can’t. Your home country MUST be missing your service 😘
Every expat here is providing a service that Caymanians are unable to. WORC demands it.
I used to work in Singapore. Caymanians need to get to the same level of education. Students graduating from public high schools in Singapore consistently outperform their counterparts in Cayman in both literacy and numeracy. According to 2022 OECD PISA data, 92% of Singaporean 15-year-olds achieved at least Level 2 proficiency in mathematics, and 87% did so in reading, with 41% reaching the highest levels in maths. In contrast, the Cayman Islands’ 2023–24 national education data shows that only 41.2% of public secondary students attained a Level 2 qualification in mathematics, and 70.7% did so in English. These results reflect rigorous curricula, well-trained teachers, and high societal expectations in Singapore, whereas Cayman continues to fail year, after year, after year, after year.
See: Why Education in Singapore Works, https://www.youtube.com/watch?v=sEn6OKsVoMs
This chasm in educational outcomes at the point of school-leaving is your main problem. Your politicians are trying to distract you by conjuring up expats as “Evil forrriners (sic) comin’ ‘ere and stealin’ our jobs!”.
Don’t fall for it. All employers want to employ Caymanians: we don’t like paying work permit fees, and we loathe the pointless bureaucracy of WORC. Presently, however, we already employ all of the capable Caymanians. There just aren’t enough of you.
It’s unfair isn’t it! Every male who went to work on ships are being considered “ a veteran” . Very few actually served in any wars anywhere. Those of us who stayed on this rock, men and women, worked, took care of the children and kept the home fires burning; have had to contribute to our healthcare and if we worked in the private sector and now retired have to pay the full costs of health coverage.
Tell us how that is fair. It’s time the Government sort this out.
who
10@20;29am – You’re likely right. But as far as I know, all living veterans and surviving spouses get a stipend.
The present CI Veterans Association, started by WW2 vets now claims to include veterans from wars in Korea, Falklands, Iraq, Balkans and Panama invasion. Most of these are of Caymanian birth or direct first-generation lineage and are eligible for membership.
What I don’t personally know is if members with full-time employment are eligible for the stipend. CIVA President Mclaughlin and others, for example.
I don’t know how that works.
yes, they are. I know someone who is still working and collecting veteran benefits. They can get it at 60 years old whether they are working or not.