By Caribbean News Now contributor
PROVIDENCIALES, Turks and Caicos Islands -- With campaigning in full swing towards Friday, when the by-election in the Cheshire Hall/Richmond Hill district will decide which party will lead the Turks and Caicos Islands (TCI) government, Premier Rufus Ewing’s National Health Insurance Plan (NHIP), sometimes derisively referred to as “Ewingcare”, and the standard of health care in the territory generally has become a central issue.
Progressive National Party (PNP) candidate, Amanda Misick, who was minister of health prior to her seat being vacated by the court, thus triggering this week’s by-election, was reported on three occasions to be looking into the cost of the NHIP by means of an audit of the health care provider InterHealth Canada (IHC). This was later revealed to be untrue.
IHC has now been operating in the TCI for three years as of the end of this month. The plan, which includes the construction and outfitting of the two new hospitals, was the brainchild of former deputy premier Floyd Hall, current premier Dr Rufus Ewing (then director of medical services) and former health minister Lillian Boyce, who replaced former health minister Karen Delancy.
Delancy revealed in a sworn statement, subsequently leaked, made to the special investigation and prosecution team (SIPT) that she lost her ministry due to disagreements between herself and Ewing.
Ewing was a member of the inner circle that contracted with IHC as the health services provider and with Johnston Construction as the hospital building contractor. The contract was awarded to Johnston without a bidding process.
The hospital buildings themselves cost $125 million and provide a total of 30 beds. The NHIP is now reported to be costing the people of the TCI approximately 40 percent of government revenue.
The entire deal was kept under wraps during the former PNP administration until member of the Peoples Democratic Movement (PDM) opposition Douglas Parnell brought it to the forefront in a House of Assembly meeting. At that meeting Boyce tried in vain to explain the reasons behind the large amounts.
Since then, Ewing has tried to distance himself from the situation, claiming that as director of medical services he was not responsible for making the decisions which brought the National Health Insurance Plan (NHIP) into being.
However, former interim government CEO Patrick Boyle pointed out that Ewing had a “central role in developing the policy that led to the creation of the NHIP”.
With the TCI under pressure to move towards a balanced and surplus budget, which includes paying down the massive debts and obligations left by the 2003-2009 PNP administration, NHIP is now the central issue being examined both for performance, cost and value for dollar.
The plan as originally advertised was promised to provide 100 percent of the population not only primary care but also first class secondary care, with only a few patients sent to the US for the most sophisticated treatments. The plan has failed to meet its goals and during the interim government administrator Desiree James was dismissed for doctoring the early financial reports to make the plan appear closer to its promised goals. The plan as promoted was expected to cost only 2.5 percent of the wages of private and public employees, while employers would pay a like amount.
This was planned to raise one-third of the cost of the plan. However, with no development, the foreign workers paying into the plan have left and layoffs of TCIslanders have caused this goal to be unachievable. The government is now bearing most of the cost. At one point, the interim government, finding itself strapped to pay the health care costs, sought to recover $10 million from the National Insurance Board (NIB) for the estimated cost of health care provided to employees under workman’s compensation and to disabled NIB recipients.
Part of the plan is the 30 beds provided in the two small hospitals, which cost an average of $4 million for each bed and room, The hospital mortgage of $120 million has an astonishingly high interest rate of 12 percent applied to its 100 percent mortgage. The will make the buildings and equipment cost the better part of $1 billion over the life of the mortgage.
Co-pays and the fact that between 40 and 50 percent of the population is not covered for secondary health care have emerged as an unexpected challenge on a second front. The promise of almost 100 percent across the board treatment has not been met. In fact, the hospitals are receiving mixed reports on their ability to provide health care anywhere near these promised goals. Therefore, patients with even routine issues are now being sent overseas for care.
Overseas care is, however, no longer provided in the US but by providers in The Bahamas and Jamaica, where costs are much lower. Delays in referrals have also been an ongoing and general problem. Often by the time a patient is stabilized then referred, their condition worsens and they have on numerous occasions lost their lives.
It was recently reported that the head of oncology for IHC is currently wanted for questioning in Canada in relation to allegations of fraud there.
The co-pays at every point of service, including medications at the primary level no longer being made available, have raised the costs to those covered and made the overall cost to the large percentage of residents not covered unaffordable. Family island primary care patients now have to travel and pay for their own medications.
These issues and many others have caused residents to call for a return to the previous plan, which had almost half the cost was available to all and included referrals to US hospitals that had agreements with a third party facilitator to provide first class secondary care for more affordable rates.
On many occasions the penalty cost of cancelling the plan has been raised, which is reported to be $125 million dollars. Former leader of the Peoples Democratic Movement (PDM) Oswald Skippings said it would be less expensive in the long run to pay this penalty cost than continue with the plan. Current PDM leader and leader of the opposition Sharlene Cartwright Robinson said the plan can be cancelled for lack of performance and an outright failure to meet its goals.
In the last week, the issue of a major health crisis brought on either by the 1,000 passenger cruise ships arriving at Grand Turk with health issues or by a disastrous hurricane and resultant injuries correlated to the small size of the ultra expensive facilities has been raised in a crisis management meeting and in the House of Assembly.
Ewing said the only way the government could afford the cost of fitting out the remaining hospital rooms is by means of a third party medical tourism industry emerging.
This problem has been ongoing for the three years of operation and appears to be untouchable by the current PNP government. In fact, the assignment of the health ministry to former backbench member Amanda Misick, who has no record of achievements in two previous terms, has been pointed to as evidence that Ewing himself has no intention of addressing this issue.
With the sidelining of value added tax (VAT), the need to reduce spending instead of raising taxes to even higher levels has brought health care costs to the top of the list of savings targets.