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Cayman Islands Government

Community Well-being

Minister for Health and Human Services the Hon. Anthony Eden, OBE, JP

Minister for Health and Human Services the Hon. Anthony Eden, OBE, JP

Statement to the Legislative Assembly, 19 March 2009

Community Well-being in the Face of the Economic Reality

Madam Speaker, for some while now, we have all been hearing about the global economic crisis, the subsequent slowdown in business and the effects that it will have on countries around the world. We cannot deny that we in the Cayman Islands are in for some rough times. Indeed, some of us are already experiencing these rough times.

Recognizing the serious nature and the scope of the current issues, my Ministry is actively pursuing cross-ministerial partnerships to align programmes and share resources as a means of dealing with the interlinked issues that is and will be facing us for some time to come. However, government agencies cannot and should not be expected to weather these storms alone.

As the Minister tasked with ensuring health and human services are provided to the people of these islands, I am acutely aware that my Ministry has a role to play in protecting the most vulnerable within our population while ensuring the well-being of all.

Human Services

I wish to comment first on services which are aimed at enhancing social and emotional well-being. It is clear from recent statistics compiled by the Department of Children and Family Services that the economic slowdown is already having an impact on the demand for their services.

Financial assistance provided by the Department in the form of rental assistance, food vouchers, school lunches and uniforms for the last six months (July 2008 - December 2008) already almost equals the entire amount spent on these categories of assistance for the previous fiscal year (July 2007 - June 2008).

Halfway through the current fiscal year, we have had to double the resource allocation for this Department.

Madam Speaker, as part of a long term strategy, the Ministry has been reviewing the criteria used to determine who gets financial and other assistance and the demographics of the individuals involved.

What we do know which is also confirmed by the National Assessment of Living Conditions (NALC) study, is that assistance such as food vouchers is predominantly utilized by female headed households with dependent children.

Informal discussions hosted by my Chief Officer with senior administrators from other ministries, have also brought other challenges to the fore, such as unemployment, work for our returning graduates, the impact of the economic stress on our nation's mental health and especially on our young children, and securing adequate health insurance coverage.

Departments under my Ministry have reported that they are already seeing the effect that the increased stressors have on our families.

I commend the proactive steps taken and thank the Heads of Departments for the input they have given to the Ministry, resulting in the formulation of policies that will have a positive impact on the well-being of our people.

It is clear that the economic issues we are currently facing have the potential to impact our nation's physical and mental health, our children's education and their current and future employment. The NALC report documents that already 1.9% of our population is poor and another 1.8% is classified as being vulnerable.

We are paying serious attention to these statistics, and doing everything we can to prevent these numbers from increasing.

In my view, only cross-ministerial collaboration and public private initiatives will allow us to find opportunities in the current situation and allow us to address the challenges holistically.

We are also promoting personal responsibility, especially in regards to the family -- people need to own up to the responsibility of taking care of their family members, in particular our elderly, our disabled, and our children. Whatever we spend now, should be an investment in the future and not just a stop-gap measure.

Health Services

My Ministry further recognizes that access to healthcare services and sufficient health care insurance is a crucial part of ensuring that people feel safe and secure, and as such it is a subject that I wish to draw attention to.

Currently, the Health Insurance Commission collects approximately $2.2 million to cover the healthcare cost for those who are uninsured and classified as indigents.

However, in the current financial year (2008/9) local healthcare cost for this group of persons is budgeted at $5.8 million. Work is well on the way to implement policies that will help to narrow the gap between the amount collected and what is paid out.

Madam Speaker, the Health Insurance Commission has recently received an increasing number of enquiries regarding what happens to your health insurance coverage if you lose or change your job.

All employed persons should make sure they maintain their health insurance coverage through these tough times. I have sympathy for the fact that when one faces possible termination of a work contract or has actually lost his/her job, health insurance might be one of the last things a person thinks about. However, it is imperative that employees and employers do all they can to keep the health insurance coverage in place.

As such, employers are reminded that their health insurance obligations do not end when they decide to terminate an employee's contract. Equally, employees should not assume that continued coverage is automatic, and they should know their rights under the law.

According to the Health Insurance Law (2005 Revision) employees' health insurance ends on the first day of the month following departure from a job. However, if employees lose their jobs and are not immediately employed elsewhere, they can keep existing health insurance for up to three months from the date of termination of work or until they gain new employment, whichever occurs earlier.

Employers are also encouraged to ensure that premiums are paid on the 1st of every month. While some approved insurers provide reminder notices, premiums must be paid in a timely manner to ensure that there is no lapse in employees' health insurance coverage.

It is imperative that employers proactively engage their staff on the issue of health insurance: As soon as you know that you have to let someone go, do the right and decent thing; sit down and discuss the matter immediately.

I am also aware of the criticism about the Standard Health Insurance Contract that has surfaced again. I know that especially our low-wage workers face difficulty in getting robust health insurance coverage.

There is a general consensus that the current level of health care benefits listed in the Standard Health Insurance Contract is not in line with today's healthcare costs. However, I caution that any legislated increase in benefits will be matched with increased cost of premiums for employers and employees.

Madam Speaker, if we want to ensure optimal well-being for all, we need to ensure affordable health insurance. This is why my Ministry and the Health Insurance Commission are consistently working to improve the system.

The Health Insurance Commission Board did make recommendations to the Ministry on an enhanced Standard Health Insurance Contract (SHIC1) plan of benefits.

In accordance with my directive the Health Insurance Commission engaged an overseas company to derive a premium rate for providing benefits under the new proposed Standard Health Insurance Contract.

The actuarial report states that "the expanded benefits under the new plan would lead to significant increases in premium rates, and the segment of the insured population that would be most affected by the premium increases are persons insured only for SHIC 1 benefits (those without supplementary benefits)."

The current premium rate for the Standard Health Insurance Coverage range from $67-$120 per month and before revising the law, Government must ensure that the mandatory plan of health insurance benefits is not only adequate but is also affordable to the average employee/employer.

Amending the standard health care plan is clearly not a decision that government can make in a vacuum.

As the Minister who introduced mandatory health insurance coverage in these Islands, I wish to remind everyone that the Standard Health Insurance Contract was meant to cover on island care, brought in to transfer some of the cost from government to the private sector.

It was never meant to cover catastrophic care overseas, but provide people, at the very least, access to inpatient service at our local hospitals.

Madam Speaker, I wish to emphasize that to the best of my knowledge no one -- Caymanian or non-Caymanian -- has been denied access locally to urgent healthcare services due to a lack of adequate health insurance coverage.

There is already a myriad of plans offered by insurance companies so any one can obtain enhanced benefits over that offered in the Standard Health Insurance Contract.

However, the question that still needs to be answered is how best to cost-effectively bridge the gap between the benefits in the basic standard plan and those in what is called the premier plan, a plan which I understand is purchased by a large segment of our population.

Members of this Honourable House should note that having received the report and feedback on the various questions surrounding the introduction and implementation of an enhanced standard healthcare plan, I assure you that the issue of affordable health care insurance for all remains high on my Ministry's agenda.

In a related matter the Ministry is also working to introduce a primary healthcare package of services to be delivered through the district health centres on all three islands. These services would include among others, GP visits, routine diagnostic tests, some medications and basic dental service.

A policy paper will be shortly sent to Cabinet recommending the delivery of this package of services at little or no direct cost to a segment of our population. This will in fact also have an impact on the benefits structure of the proposed the Standard Health Insurance Contract (SHIC1).

Madam Speaker, in conclusion, I want to make it clear that simply increasing health insurance coverage or providing social assistance is not the answer. The Ministry or Health and Human Services is not looking for quick fixes, but instead we want to find solutions that will put social development on par with our islands' physical development.

There must be a national strategic approach to deal with the economic slowdown and its effects, and my staff is exploring ways to meet the growing demands creatively. The recent restructuring of Health and Human Services and its departments, has laid the groundwork for such a response, and has already proven to be a sound investment.

While agencies under the Ministry are committed to supporting those who are most vulnerable and are well positioned to maintain the current range of services during these difficult times, if we are truly to achieve optimal well-being for all, we will need public, private and personal partnerships.

As such the community and businesses are encouraged to get involved in supporting our people during the difficult times ahead. We need to ask ourselves what it is that we can do to get through this, and how can we as a people stand together to weather the storm?

Today, I also ask all Members of this Honourable House to join in this crucial venture of ensuring optimal well being for all.

For further information contact: Cornelia Oliver