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Published 13th June 2006, 12:22pm

HIC Superintendent, Mervyn Conolly, discusses the factors that make up the standard health insurance fees as James Cleaver of Kroll Cayman looks on.

Even though it is mandatory here in the Cayman Islands, as much as 25 percent of the population may still be without health insurance in spite of laws requiring employers to provide coverage.

The Superintendent of the Cayman Islands Health Insurance Commission (HIC), Mervyn Conolly, said his agency is actively pursuing employers who are not compliant with the law.

"The HIC has targeted the construction industry as we have received many complaints from workers in this field," said Mr Conolly.

"Construction work can be high risk from falling off roofs to operating dangerous equipment, so it is important that construction workers have adequate cover. We have also met with the Contractors Association and they are cooperating."

Other industries that have been targeted for non-compliance have been the security services and domestic workers. Although Mr Conolly acknowledged that many complaints come from workers in low wage earning positions - he stopped short of saying that non-compliance is focused in this area.

He added there were much fewer complaints from workers in higher paying fields, such as in the financial services industry.

According to the latest figures of the HIC there are 41,000 people with health insurance coverage in these Islands. With the population estimated to be between 50,000 and 55,000 that leaves the uninsured numbers at 9000 to 14,000 people.

The Health Insurance Law requires all employers to insure their employees regardless of them being temporary or long term work permit holders, part or full time, or domestic workers.

The high cost of health care and health insurance has been a concern among businesses and the community. It might be difficult to afford health insurance premium for some low wage earners, but Mr Conolly explained that it is even more costly if there is even one catastrophic illness or injury, which can easily run up to tens of thousands of dollars.

That is why it is important to have the minimum standard health insurance plan, which is really a hospitalisation plan, he said.

These monthly premiums for this basic plan are more economical but they provide minimal coverage for outpatient care. Better health insurance coverage is typically provided to by higher paid positions and top firms. Industry experts have noted that higher wage earners have more ability to pay for their own medical costs.

According to the Minister of Health Service, Hon Anthony Eden, the Cayman Islands is the first country in the world to mandate health insurance for all residents. Recently two states in America, Vermont and Massachusetts have recently enacted similar legislation.

Stakeholders from insurance, health care providers and employers have stated there are issues in providing health care at affordable costs. Some private practice doctors have stated there is not a big enough population base.

If insurance companies do not pay them for some treatments it is hard for the doctors to make up the income without a high patient volume, something that is possible in the United States.

Insurance companies have stated that patients frequently over-utilise the insurance for unnecessary treatments, which then in turn drive up insurance premiums.

The Health Services Authority (HSA) has said the Accident and Emergency Room is overused for non-emergency health care.

Another concern is that health insurance companies reimburse health care treatment at various rates, which has caused issues for health care providers in the regard of what to charge the patient. That is why the Standard Health Insurance Fees was implemented in July 2005, which determined the minimum reimbursement paid by insurers.

On 16 June, HIC announced a study to review Standard Health Insurance Fees and running a medical practice. Kroll Cayman Ltd will be doing the study in conjunction with Mercer Oliver Wyman Actuarial Consulting.

Kroll will be surveying local physicians about their expenses to determine how much it costs to operate medical practices in this country. This information will then be used to make any necessary adjustments to the Standard Health Insurance Fees.

The Chief Officer of the Ministry of Health Services, Diane Montoya, said funding health care is a complex process.

"We need to shift the costs of health care from Government to employers and the patients," noted Ms Montoya. "There are many factors in costs of health care and premiums. The Ministry of Health Services has been gathering data so that it can have the necessary information to make decisions about the costs of health premiums."

She explained that doctors need to be confident that when they take an insurance card they are going to be reimbursed and not incur debt in the process. Collecting data from this survey will be an important piece in the whole puzzle so that the Ministry can forge a holistic policy that considers the needs of all stakeholders: patients, employers, health care providers and insurance companies.