National Health Financing. November 2011
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1 National Health Financing November 2011
2 British Overseas Territory Population of 54,000 3 Islands Grand Cayman, Cayman Brac, Little Cayman Large expatriate workforce (approx. 50%) No direct taxation Main economic pillars are finance, tourism, and development.
3 2 Public Hospitals Cayman Islands Hospital on Grand Cayman (124 beds) and Faith Hospital in Cayman Brac (18 beds) One private hospital on Grand Cayman Private physicians also provide primary care
4 Health Insurance Law & Regulations require all residents have a minimum level of health insurance (Standard Health Insurance Contract SHIC ) The Health Insurance Commission regulates and monitors compliance with the HIL Approx. 48,000 of 54,000 population are reported as having health insurance 20% of insured are at the SHIC level others have supplemental plans
5 8 Approved Health Insurance Providers One is a Government company Cayman Islands National Insurance Company (CINICO) CINICO provides health h insurance for Civil il Servants, Civil Service Pensioners, Seafarers and Veterans CINICO also provides health insurance for those individuals who have been refused cover by private insurers ( health impaired ), elderly, and low income
6 CINICO premiums (2011/12 budget): Civil Servants (8,000 enrollees)-$30.7m Civil Service Pensioners (1,840 enrollees)- $14.6M Seafarers and Veterans (1,320 enrollees, local care only)- $9.2M Indigent (ASO) (1,180 enrollees) $270k
7 Outputs from the HSA: Local care for Indigents - $8M Sister Islands- $3.8M Ambulance - $2.1M District i t Clinics i - $3.1M Mental Health - $1.9M Pediatric - $355k Accident & Emergency - $264k Geriatric Services - $815k Under / Uninsured Children- $1M School Health - $1.5M Under / Uninsured Chronic Ailments - $1M Public Health - $1M
8 NGS 55 Overseas care for Indigents, Seafarers, Veterans currently forecasting $15M for 2011/12 FY Advance Patients under / uninsured patients requiring medical loans amount varies TOTAL Approximately $95M Nearly 20% of total budgeted expenditure
9 No direct taxation Revenue from: Segregated Insurance Fund approx. $2 M/ann. Work permit fees Import duty Company fees Tourism fees
10 Amendments to Health Insurance Law & Regulations Enhanced benefits under the SHIC to help reduce number of underinsured. Elimination of underwriting for SHIC Introduction of wellness benefit under enhanced SHIC Allow for portability of supplemental benefits Expanded definition of Dependent Offspring Increased penalties and administrative fines for violations of HIL
11 Introduction of CayHealth at the HSA Piloting i with Indigent population Alignment with primary care physician to increase emphasis on wellness, compliance, etc. Redefines access e.g. appointments with Specialists only through Primary Care physician Currently fee-for service, looking to move to capitated model after pilot period Hope to roll out to all HSA patients once evaluation of pilot is complete Should help save costs longer term through prevention and wellness
12 Introduction of EVAS system for CINICO clients Partnership between the HSA and CINICO Will help to reduce HSA administrative costs for claim processing Will reduce CINICO s expenditure on TPA for claims adjudication di i Will provide a means to educate patients regarding the cost of their healthcare Plan to roll out on a national level once successfully implemented at this level
13 Healthcare Costs Review Committee Looking at ways to reduce Government expenditure on healthcare such as: Alternate destinations for overseas care Review of eligibility criteria for government-funded programmes such as indigent, seafarers, veterans Review of Civil Service and Civil Service Pensioner plans Enhancing co-ordination of benefits for CINICO clients Wellness programme for CINICO insured Introducing a new Health Insurance Premium Assistance Programme (with enhanced SHIC)
14 Medical Tourism / Dr. Shetty Hospital In 2010, Government signed an agreement with Dr. Devi Shetty regarding a tertiary medical tourism facility in the Cayman Islands Proposed to be built over several years, Dr. Shetty plans an ultimate build out of 2,000 beds Local patients will be able to access tertiary care that they currently need to travel overseas to receive Dr. Shetty says he can deliver this care at 60% less than we currently pay in US hospitals Currently in design stages first phase (120 beds) should start construction in 2012
15 We cannot afford to continue with the status quo we are actively seeking ways to reduce Government expenditure on healthcare without compromising quality, patient safety, or access to necessary care. We hope that some of the initiatives we are currently working on will help us achieve that goal.
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