Letter to the Editor

New National Insurance Company – panacea or not?

Tuesday, April 20, 2004

Dear Sir,

Excellent health care for all is a goal worth pursuing. 2000 was the year set by the World Health Organisation (WHO) to attain this goal, but, unfortunately, it failed miserably.

Inequities in the distribution of global wealth and resources, distorted priorities, lack of political will, improper use of available resources, waste, poor access to health care, poor system design in the delivery of health care, lack of co-operation of those who can help, counter productive cultural influences, cockeyed value systems, fraud and corruption, inadequate public health education and ignorance, are but some of the reasons for this failure.

While the developing world still grapples with poverty and the ravages of starvation, malnutrition and infectious diseases, the developed world struggles with the problems of an aging population, degenerative diseases and the growing threat of the developing world where most of the population is below 25 years of age.

Compared with that backdrop, we here in Cayman are pretty fortunate, but this is no reason for complacency. This is not the time for finger pointing, name-calling or recklessly blaming anyone. Rather, it is a time to work together, utilizing that know-how which does exist in our community to devise a system which guarantees excellent health is for all of us who live here, and for those who visit our shores.

We are where we are today, because of the efforts of many. Past and present Governments have placed a fairly high priority on health care and we are blessed to have three modern well-equipped hospitals in these Islands, and per capita medical expertise, which exceeds any Island in the Caribbean.

I know of no other Government, which is prepared to stand the upfront costs for any of its citizens who are referred overseas for medical care. Government policies are very generous: civil servants and their dependents, seamen, veterans, indigents and others are entitled to free medial care, if they use the Health Services Authority facilities.

A few years ago, health insurance was mandated by Government to improve the situation, but unfortunately, many individuals were unable to purchase health insurance.

To avoid autocracy and in the spirit of free enterprise, Government chose not to force private health insurance companies to sell insurance to all applicants.

Today there is a growing percentage of persons classified as uninsurable, some times for trivial reasons such as being 20lbs overweight and it is near impossible for senior citizens to purchase health insurance even if they can afford it.

Health care costs always outstrip inflation and even powerful economies like the USA and the UK struggle to find funds to finance it. Currently Canada is considering yet another health tax.

The Cayman Islands has a restricted tax base, we pay no income, poll or health tax, and it is no wonder the Government is financially strapped to continue its generous policies.

The big question is, is Cayman Islands National Insurance Company (CINICO) the panacea to our problems? CINICO was recently launched by the Government.

Before now, the Government paid the Health Services Authority (HSA) directly for services rendered to those entitled to free benefits.

Now CINICO will pay, from premiums paid by the Government. Persons denied health insurance coverage by private health insurance companies are, no doubt, elated for the opportunity to purchase coverage from CINICO.

As someone who has worked in the health care field for a quarter of a century, in the Cayman Islands, I have to make the following observations:
CINICO should be financially sustainable. The premiums may as well be right from the start, if not Government will be forced to ask civil servants to pay half of their health insurance premiums, like everyone else does, impose some sort of tax, or once again reach painfully deep into its coffers.

Genuine uninsurables can gobble up lots of care, and the premium had better be right.

Government already knows the annual cost of health care for those entitled to free care. At the very least, the premiums need to cover that cost, plus the administrative costs of CINICO. This begs the question whether CINICO makes financial sense.

CINICO will end up covering at least 40 percent of our population, and one should hope that those covered will be entitled to receive their benefits, irrespective of who they choose to go to.

For all these persons to be deprived of freedom of choice of provider is a regressive move. The patient/doctor relationship affects medical outcomes greatly and every effort to enhance it should be made.

Moreover, does it give any health care provider incentive to deliver excellent health care if they know that the patient is forced to see them?

I am not suggesting that CINICO should pay a private health provider more than its prescribed benefits, but, it should be left to the patient to see who he or she wishes.

Some private practitioners habitually see elderly persons who were once able to pay them, but can no longer do so. Some of these senior citizens are entitled to free benefits from the HSA.

Up until now, private practitioners could write a pharmacy prescription for them and request lab investigations and physiotherapy services and they were honoured by the HSA. I am told, that this practice will cease and I believe it is a crying shame.

Civil servants are no better off than they have always been, they still only receive free care if they utilize the HSA services primarily.

Many of them prefer to see private doctors, and why shouldn’t they have the choice?

Here is an opportunity to extol good customer relations, simply by making benefits universal. I am not suggesting that CINICO should pay more to a private practitioner than it does to the HSA.

One should hope that CINICO does not engage in anti-competitive practices. This practice recently featured prominently in the news.

Conceivable CINICO could charge unsustainably low premiums to start with if it opens its gates to the entire public for just long enough to drive all the private health insurance companies out of business, then what?

Most of us do not relish monopolies for obvious reasons.

Compared to many other countries, the quirk and woes in our health care system are miniscule, and the good news is, it is still not too late to rectify them.

I would truly welcome the opportunity to discuss my views and concerns with our Government or anyone who can make a difference.

Dr S A Tomlinson MB BS FRCS LRCP
Physician and surgeon

Back...