Hey everybody – look! The health care system is in the crapper!
Surprise, surprise, surprise… the HSA and CINICO continue to be the biggest financial mess and are the combined recurrent budgetary abortion for the government with projected deficits of nearly $18million for 2008 according to a Caymanian Compass page one story on Monday.
Are the HSA and CINICO board members and staff asleep at the wheel, lazy or just embracing an attitude of defeat?
I’m going to go ahead make a comment here regarding the HSA and the term “acting” CEO: Someone – and I don’t care who that someone is – needs to stop “acting” like a CEO, sprout a pair of nuggets and actually BECOME a CEO.
Eighteen million dollars lost – projected. It could be worse; and based upon historical performance it probably will be.
Eighteen million dollars - wasted.
If there are 50,000 people in Cayman that equates to $360 for every man woman and child – wasted, lost, pissed away… gone. Gone because people aren’t doing their jobs.
What’s happening now with the HSA and CINICO is “stupidity” defined. Stupid – 1) repeating the same act and expecting a different result; 2) – consistently putting unqualified people into positions of authority in the HSA and CINICO and expecting both entities to suddenly heal themselves.
So what’s the answer?
“Acting” CEO Lizzette Yearwood and the HSA geniuses had the great idea to raise the fees charged for services rendered and decided as well to not fill certain vacant positions (some possibly doctors and nurses) at the hospital. So basically she’s proposed cutting the hospital’s operational capacity and raising prices; and she’s completely missing the obvious.
Even though the words came from her mouth, Yearwood ignores the most obvious culprit of the financial disaster. Here’s the quote from Monday’s story: “The system currently covers all civil servants, their spouses and children, and pensioners at no cost to those who are covered.”
“At no cost” – there’s the problem.
Stay with me here. Let’s assume there are 3,000 civil freeloaders and half of the 3,000 are covered under the government’s “at no cost” health plan as employees alone and the other half for full family. At a conservative estimate of $250 per month in premium for the employees and $500 per month premium for the families (which is grossly understated), the premium generated by civil servants alone would be $13.5 million per year.
Based upon actual distribution of plan participants and dependents, and plan costs, this $13.5million would more than likely increase significantly and would surpass CINICO’s deficit.
Add to that the requirement that civil servants pay deductibles and coinsurance and the HSA could actually begin seeing a more robust revenue stream from the population that is the number one user/abuser of the “at no cost” scheme.
By making civil servants financial stakeholders in the system we’ve generated premium dollars for CINICO and a revenue stream for the HSA. And all by doing nothing more than asking civil servants to do the same thing we do – pay their fare share.
Will this completely remedy the comedy of errors now playing out every day in Cayman’s health care theatre? No; but it will work better and more economically than cutting staff and raising fees because doing so doesn’t necessarily cut costs in the long run.
“Why not?” Well I’m glad you asked. Consider the following:
If you cut staff you reduce normal payroll but increase your overtime exposure. If you reduce staff you reduce the number of man hours available without reducing the work load, which means you are forced to pay overtime to adequately deal with the existing workload or you are forced to keep your doors open and lights on longer to complete a day’s work.
OR you screw the patients, shut the doors and force them to the emergency room at significantly higher costs to them and the insurance company. This may save the HSA money in the short term, but it will screw the patient on provision of care AND cost. But hey – it’s easy to do. Am I the only who can see the writing on the wall here?
So, let’s increase the fees. Hmmm… If you increase the fees you generate more accounts receivable – but the trick is turning the accounts receivable into revenue; something the HSA has proven entirely incapable of doing especially given the old Caymanian adage of “you can lead a man to the HSA but you can’t make him pay.”
Further, if you increase the fees then the patients’ insurance companies either a) pay the increased fees submitted by the HSA or b) pay the standard fees in accordance with the law and the HSA is left billing the patient for the balance – which leaves outstanding A/R on the books and doesn’t have the intended affect (shocking, I know).
Don’t let people like Lie-zette Yearwood convince you that by firing a few porters and raising fees the problem will be solved, because it won’t. If the HSA raises its fees we all know who pays those increased fees, and it isn’t CINICO, the civil servants, or the “underserved” population of Cayman.
And don’t let Gordon Rowell fool you into thinking that the solution is as simple as, “We have to address changing demographics.” I gotta tell you Gordon – if you guys haven’t already addressed “changing demographics” we’re all screwed.
Demographics won’t generate non-government subsidies for CINICO; proper management of the HSA and CINICO will. Demographics didn’t put the health care system in the toilet; foolhardy political myopia got Cayman into this position.
Demographics didn’t create the laws that burden Cayman with a restrictive, expensive and unsustainable health insurance industry/product: foolish and ignorant politicians did. Change THAT.
Demographics didn’t continually allow the HSA to be mismanaged and to continually underperform from a service standpoint AND a financial standpoint: foolish politicians did by appointing unqualified people to positions of authority and allowing those people to ruin the hospital. Change THAT.
Demographics didn’t forbid insurance companies from free and open competition within the Cayman insurance market: a pissed-off minister with a bad attitude and an axe to grind did. Change THAT.
Demographics has nothing to do with the fact that more than 10% of the Cayman population pays not one penny toward the cost of their health care – and the government and paying customers/patients end up bearing the cost. Change THAT!
We don’t need to address “changing demographics” we need to address changing the philosophy. We need to address changing the cost metrics. We need to address changing the leadership dynamic. We need to address changing the administration structure of both the HSA and CINICO.
The only demographics that need changing are the demographics of both boards – so Gordon, my mistake. You are correct. Regardless - blame increasing health care costs on Cayman's demographics or the global economy if you must, but the $18,000,000 deficit is the sole result of poor policy; and those in charge should be sacked yesterday.
I’ve said it many times before and I’ll say it again: the HSA board is entirely incapable of running a hospital and the latest bailout and potential staff cutback and fee increase is irrefutable proof. And as a result of pathetic HSA management, CINICO is forced to rely upon the government’s retarded and bankrupt step-child for revenue.
The hospital needs professional management – period. CINICO is in very capable hands with Gordon Rowell but even he is incapable of turning crap into gold (if you don’t believe me, play a round of golf with him).
Regardless (and all due respect to Gordon), this has nothing at all to do with “changing demographics” and everything to do with changing the paradigm from one of well-intentioned ignorance and systemic stupidity to good governance and fiscal responsibility. People need to swallow their pride and admit that they are wholly unqualified by education, experience and training to run a hospital. Then they need to hire the right people to do the job and LET THEM DO IT. Finally, they need to include all gainfully employed participants in the financial responsibility of health care.
There are 18 million reasons why Cayman needs to disband the HSA board and turn the hospital over to a professional management company; and there is one reason why it will never happen: Fear. No one is strong enough to make the right decision to fix the boards and force civil servants to be financially engaged in the provision of all aspects of their health care.
And the two people who would have (Michael Elliot and Craig Brown) were fired NOT because they weren't doing their jobs, but because they did their jobs correctly and people's feelings were hurt. I have two words for the HSA and CINICO - boo freaking hoo.
Eighteen million dollars knowingly, consciously and willfully flushed down the toilet. Suddenly two dudes making out at Royal Palms seems pretty insignificant.