December 11, 2019

GAP analysis and reform proposal for Healthcare Funding in the Cayman Islands

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PART I – Introduction to Identified Gaps in the Cayman Islands Healthcare Funding System

We are pleased to share with you the first part of a review of the systems of Healthcare Funding that has been conducted by the Health Insurance Standing Committee (“HISC”) of the Cayman Islands Insurance Association (“CIIA”).  The HISC has spent the summer of 2019 identifying gaps in the current systems of Healthcare Funding, assessing the financial and social impact of these gaps, and creating proposals on how to close these gaps.  Healthcare is important to us all, and we have determined that it is in everyone’s interest that the expertise of every member of the HISC be brought to bear in providing solutions that better serve our clients and the wider Cayman Islands community. 

The attached document is the first of four parts which is an introduction to the healthcare system, the identified gaps and our perspective on possible solutions.  Over the coming months three more parts of this document will be sent to you, as well as published on the CIIA website. 

PART II – Healthcare and Funding Gaps for Vulnerable Populations

We acknowledge and cover as our first priority groups of people who are most vulnerable to being underserved in our current system, either by diagnosis or by socio-economic position.  These include

·         Mental Health Care and Coverage

o   Mental health care not sufficiently defined

o   Mental health care not treated as any other illness

·         Retirees and Elderly Care and Coverage

·         Public Covered Populations – Seamen, Indigent, Civil Service

·         Neonates and Newborns with Congenital Defects

·         Dependents after death of Primary Insured

PART III – Health Insurance Infrastructure Gaps

There are parts of the current regulatory framework that are either outdated, under maintained, or defunct.  These are resulting in glitches and malfunctions in the current system of healthcare funding.  Some of these are

·         Missing Categories of Codes for Standard Health Insurance Fees (“SHIF”)

·         Irregular Review of SHIF

·         Irregular Review of Standard Health Insurance Contract (“SHIC”) Standard Premium Rates

PART IV – Healthcare Provider Infrastructure Gaps

There are many significant gaps in the way in which the delivery of healthcare is regulated in the Cayman Islands that we believe to be having a direct effect on the rising cost of healthcare and, as a result, on the rising cost of health insurance.  The topics to be covered in Part IV include the following:

·         No standards of transparency of billing

·         No accountability for complaints

·         No induction into Cayman healthcare system required for new healthcare providers

·         No quality standards (Public Safety)

·         Insufficient due diligence on new providers

·         Peer review to regulate conduct of providers

·         Healthcare providers do not respond to HIC surveys

Notes:

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