(CNS): As the Cayman Islands Government battles with numerous problems associated with health insurance, including prohibitive costs, Finance Minister Rolston Anglin has revealed that the government-owned Cayman Islands National Insurance Company is running a pilot programme to allow its health insurance coverage to be accepted at private medical facilities without an HSA referral.
The minister told parliament that around 100 CINICO employees and their dependents are in the first phase of this programme to work through any problems associated with it, with a view to eventually allow all those insured through the government company to access the private medical care market.
The most pressing issues with local health insurance include the extortionate cost of coverage, which is crippling or simply unaffordable for many on the islands, especially seniors, and the fact that private insurers can choose not to insure those with a higher risk of medical problems, ensuring their own profits and leaving the government to pick up the bill for the under- or uninsured.
Last week the health minister appropriated another $27 million in supplementary funding for four areas of care largely for the under or uninsured, and elderly. This is on top of the existing budget for just four areas of around $50 million.
The fact that health insurance is tied to employment is also a huge and growing problem, as many people who retire from the private sector find that they no longer have any, just when they need it the most. When CINICO was first introduced in 2004, it was envisioned as eventually becoming a true national insurance agency, open to all, but this has never happened.
While this latest expansion of CINICO does nothing to address these issues, it will likely be welcome news to civil servants and others covered by CINICO who want the option of seeking alternative healthcare providers, rather than be confined to the Health Services Authority except where the HSA provides a referral.
As he answered a parliamentary question on the issue earlier this month, Anglin said that CINICO had made progress in establishing arrangements with private healthcare providers to have its health insurance coverage accepted at some private medical facilities. “This arrangement is currently implemented on a limited basis and it has not been extended to civil servants,” he said.
“The background to this subject matter goes back to 2021 and 2022, when the government at the time was considering the expansion of CINICO’s health insurance business. At that time, one of the proposals was to establish a local provider network that would allow civil servants and other CINICO insured persons to have a greater choice of healthcare providers, including private facilities.
“It was also expected that this could make healthcare coverage with CINICO more attractive to Statutory Authorities and Government Companies and support the development of new health insurance products for the wider public,” he noted. SAGCs have never been mandated to use CINICO, and those that choose not to include the HSA.
However, Anglin noted that if a significant amount of healthcare provision moved away from the HSA, this could negatively impact the government hospital.
“There was also insufficient information on how many civil servants would use private healthcare providers and what the resulting cost to government could be. For those reasons, the consideration of extending a choice of private-sector healthcare providers to civil servants, without requiring a referral from an HSA physician, was not progressed.”
He said that rather than introduce a wider programme without reliable information on utilisation and cost, the CINICO Board of Directors decided to establish a pilot programme for its own employees and their dependants, as they would be an easy group to manage during the pilot stage.
This will allow CINICO to gather information on how the network is used, the cost of providing the additional choice, and any operational issues that need to be addressed before consideration is given to a wider rollout.
In July this year, CINICO activated the first phase of the Preferred Provider Network with Health City Cayman Islands and Doctors Hospital to begin testing the arrangements and work through the practical requirements.
Anglin said CINICO plans to expand the network in phases. The second phase, due to start this month, will still be restricted to CINICO’s own employees and their dependants but will expand into private dental clinics and pharmacies.
“The third phase will cover selected general practitioners and specialists and is expected to take longer because of the number of providers that must be assessed,” Anglin stated in the answer.
“CINICO has indicated that this phase may continue until the end of the first quarter of 2027. Healthcare providers joining the network must agree to CINICO’s requirements, including agreed fee arrangements and discounts, no balance-billing of members above the agreed amount, and CINICO’s audit and administrative requirements.”
The minister added that the pilot is important because the government still needs reliable evidence on utilisation, cost and the wider financial impact before any decision is made on extending this type of access to CINICO clients generally.
Any wider extension would therefore need to be considered separately, taking into account both the cost to the government and the potential impact on the HSA, he said, and committed to updating parliament as the programme rolls out.