fp Turks and Caicos

The Turks and Caicos Islands interim government is seeking public input on how to reduce the cost of a two-year-old health care system that the country now cannot afford.

Some proposed remedies include increasing payments to the National Health Insurance Program (NHIP), renegotiating contracts with InterHealth Canada for operating the two hospitals, adding or increasing co-payments for services, limiting services for temporary residents and improving delivery of drugs.

The depressed economy hit the system hard by reducing the number of foreign workers who left when jobs dried up, reducing NHIP contributions that help pay for the nation’s health care, according to the government’s Public Statement on the Health Care Funding Challenge published Oct. 11.

The total annual cost of health care is approximately $61.5 million. NHIP contributions pay for only $19 million, while the government picks up the $42 million difference. Costs include:

• $20 million to InterHealth Canada Limited (ICL) for infrastructure and equipment costs
• $24 million to ICL for clinical services to operate the hospitals
• $12 million to NHIP for overseas treatment. NHIP paid out just over $9 million on overseas care and applied the balance to fund the Wards of the State, pharmaceutical program and payments to local private primary care practitioners.
• $5.5 million to government primary health care programs, including emergency services and mental health and long-term care.

Because of tight budget constraints, the Ministry of Health and Human Services has had to suspend or downsize a number of its programmes, including closing the AIDs Hospice on Providenciales, merging the residential homes in South Caicos and Grand Turk for persons with special needs, and suspending operation of the Animal Pound on Grand Turk.

One problem is that several integral parts of the health care plan of the previous elected government were never implemented by the interim government under direct U.K. rule.

A Health Regulatory Authority to govern and monitor many aspects of the health care delivery process has never been created, despite repeated calls by the governor’s Consultative Forum and others. Neither has primary health care been upgraded or a Healthy Lifestyles Initiative developed.

Progressive National Party Leader Clayton Greene blasted the interim government for not following through with the program that his party pushed through to improve health care on the islands.

At a press conference Oct. 12, Greene said a clinical services review board has only recently been appointed but has not yet met, and a contract management board to deal with InterHealth Canada has been ineffective.

Greene and Royal Robinson, a former PNP minister who was a chief architect of the health care program, said the interim government could have prevented much of the funding problem by encouraging inward investment that would have boosted the economy and employment, which would increase NHIP contributions as well as government revenue.

The government said some parts of the plan need to be improved, such as reducing the high cost for medical treatment overseas. While NHIP reduced the cost from $36 million for 10,000 Turks and Caicos Islanders in 2008 to $9 million for more than 30,000 beneficiaries, the cost is threatened by “an open door, no limit policy as required by current legislation.”

Also increasing costs is unlimited funding for medical care overseas for migrant workers who don’t permanently reside in the TCI and unlimited funding for their dependents, regardless of the number of dependents.

Illegal immigrants do not make any NHIP contributions, but they get treatment on humanitarian grounds and under international accords and agreements. Projections for how much that would cost were underestimated.

The government also said a poor health information system provides inadequate information for effective decision making.

Currently only those who are employed contribute to NHIP, meaning approximately 11,000 dependants are being supported by 18,000 contributors. Requiring minimum monthly contributions for spouses and children could increase revenue significantly, the government said.

The government suggests allowing long-term residents not currently eligible for coverage, such as retired persons and winter visitors, to join the program to increase contributions.

Other ways to increase income would be applying a “sin tax” to tobacco, alcohol and high sugar content products that would go only to the health care budget, and encouraging health and medical tourism, of which the government would receive 50 percent of revenues.

The 11-page Public Statement on the Health Care Funding Challenge is available on the government website at www.gov.tc.

Government is asking for comment from the public on the proposed options. Comments should be e-mailed to This e-mail address is being protected from spambots. You need JavaScript enabled to view it and/or mailed to CEO Turks and Caicos Islands Public Service, c/o Tito Lightbourne, NJS Francis Building, Grand Turk.

Questions for Consideration
1. Should the government aim to re-negotiate the contract with ICL?
2. Should the present NHIP financial imbalance be addressed by increasing contribution rates, or reducing benefits, or both?
3. Should NHIP contributors with dependants pay higher contributions than those without dependants, if they can afford to?
4. Should co-payments on pharmaceuticals, dental and optical care be increased for those that can afford them?
5. Should co-payments be introduced for all healthcare treatments, except for those that cannot afford them?
6. Should a minimum residency period apply to membership of the NHIP and new immigrants would only receive the minimum benefits required under international conventions?
7. Should NHIP benefits be restricted to urgent treatments only?
8. Should medical practitioners be expected to take their share of reducing healthcare costs?

The cut-off date for comments is Oct. 31.

The Ministry of Health and Human Services will produce a follow-up paper to provide details and costs of the various options.

Click here to read the government's Public Statement on the Health Care Funding Challenge

Click here to read Greene's prepared statement