Free healthcare for CS no longer an option

| 21/01/2011

(CNS): A clear message was sent out at a conference geared at turning around Cayman’s healthcare system, with high level officials calling for a change in the way civil servants, who currently receive all their healthcare premium costs paid for by government, receive their healthcare benefits. Canover Watson, Chairman of the Health Services Authority, called for the “entitlement behaviour” of civil servants to end. “This entitlement culture has to be addressed. Until there is shared participation in healthcare there is no incentive to change,” Watson said. (Left: James Watler – Photo by Dennie Warren Jr)

The HSA chair was speaking at the Cayman Islands Healthcare Thought Leaders Forum held at The Ritz-Carlton, where the controversial issue was raised. Watson said a sacrifice for the greater good was needed. “The civil service is a large voting block for government, so it will take political risk to make the change … Whatever plans we implement, however they are structured, there needs to be change,” he added.

The health minister also said that, given the country’s growing and aging civil service, the unlimited medical plan for civil servants could not continue. “I don’t know of any other organisation in the world that pays 100 per cent medical coverage. It is unsustainable,” he said. “We have no tax base and our revenue is declining … We need all the different groups on board to address the issue.”

However, James Watler, President of the Cayman Islands Civil Service Association, (above) vociferously defended the civil service and said that his association had tried many times “to conduct dialogue with the government in this respect."

Lizzette Yearwood, the Health Services Authority’s CEO, said the HSA wanted to keep that dialogue going as she believes that the momentum for change had already begun and that Cayman could not continue where it was. She pointed out the recent steps to change the health insurance legislation to ensure that more people were effectively covered and the evolvement of CayHealth, the initiative designed to take the pressure off emergency and acute care services using preventative healthcare measures and providing primary healthcare.

Kenneth L. Di Bella, President & CEO of CBCA Administrators, Inc, which works with the Cayman Islands National Insurance Co (CINICO), organised the event in a bid to address the issue of Cayman taking responsibility for directly contracting health care providers instead of using a third party or “middleman” at great expense.

Di Bella also presented the idea of introducing wellness and disease management programmes into Cayman in a bid to encourage people to take responsibility for their health and stem the rise in chronic conditions and thus reduce healthcare costs.

After it was pointed out that there was no reason to try and incentivise individuals to look after their health when they already received 100% free health insurance coverage, Di Bella said that the system would have to look internally to see whether it could continue.

“I suggest a system that gives free healthcare cannot continue,” he said. “But you need the political will to make the change.”

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  1. Michel Lemay says:

    There are no doubts in my mind where the UK stands on this. The civil service as grown tremendously since it’s inception and to expect totally free healthcare in today’s difficult time is a sesible subject for both parties. While the CS has already been asked to accept a pay cut and makes it more difficult for some to make ends meet. I too think it’s time for the CIG (Cinico) and CS to try and address this properly before unpopular decisions may have to be made. A small and fair compromise would be a good way to start so that both find some sort of common ground. I am not certain what the solution is but if we ihink out of the box for a minute I think that salary brackets could be looked at and possibly a percentage agreeable that would be fair across the board. Many not involved L know many will scream cut the CS by reducing it but let’s face it someone as to pay and at the end of the day if it can be achieved by beginning somewhere we all be better off. Those on contracts I appreciate your point but like in the private sector sometimes compromise have to be made that would not add to our unemployement situation. Food for your thoughts in a positive manner and please remember to be respecful of our Premier while he and both the Bush and Anglin familes mourn their loss in ALL our comments in the other sites as well while we discuss issues. Instead lets keep them in our prayers.

  2. Adam Smith says:

    The problem is that in Cayman anyone who works for government is talked about as a "civil servant".  Providing the same level of perks to a garbage collector as a senior government manager makes no sense. 

    It would be better to cut the long term perks for all the non-professional "civil servants" (i.e. pension and health care benefits) because otherwise Cayman is storing up broad future liabilities which it will never be able to afford.

  3. Anonymous says:

    All this only shows that Caymans health care system is up to the Caymans Government standards along with all the rest of its failing systems.

  4. Anon says:

    My partner used to work in CCU at GT Hospital. Stories included :

    Caymanians bringing their elderly relatives into hospital for x-mas, easter, new years, or when they wanted to go off island for a vacation, as they did not want to be burdened with them. Amazingly the hospital took them.

    Certain managers placing their relatives in the CCU ward as they did not want them on the general ward for some reason.

    Caymanian and civil servants absolutely raping the health care system, extending their entitlements to their whole family where possible.

    Lot’s of people not getting billed for health care.

    Caymanians getting billed for healthcare, who would then complain to government officials high up, so they would not have to pay their bill (and bill’s were waved on occasion).

    Good / experienced doctors and nurses not having their contracts renewed because they would speak out against poor management decisions in the hospital.

    A management committee that for some reason was heavily influenced by a well meaning but clueless member of the church (since when did a clergyman have any expertise on medical matters.)

    In a management meeting, having sacked many of the good doctors, someone asked ‘what will we do?’ The response ; ‘we all have to pray.’ This was the extent of the managements problem solving skills at the GT Hospital.

    And everyone wonders why the hospital is broke!

  5. anonymous says:

    It is obvious what the Government is is Setting up the CS. They will simply say to the UK “we tried and they rejected all suggestions and cuts, just mandate what you want us to do”.

    Given that the UK government has slashed and burned their own CS, I know what they will say about ours. Their CS cuts in Turks & Caicos is a good indication. Salaries are now paid there long after months end.

    The existing Government will not pull the trigger but let the UK do it however the gun is being loaded and cocked for them, that is clear.

    My suggestion is that the CS meet the Government half way now rather than have the UK pull the carpet from under them in a few months.

    CS, please think about this rationally. Some pain now or a lot of pain later.

    • Anonymus says:

      Meet them half-way where? The Government hasn’t proposed anything yet. They haven’t even begun a discussion with the CS. People are just shouting for blood with no numbers or rationale or suggestion. And the last time we met them half-way we got a pay cut and got in return ….

      Meeting someone half-way implies thatboth sides get something out of the deal. What, exactly, are you suggesting that the CS get, other than shafted? Remember, CINICO & HSA have both reported ‘profits’ over the last year or so so where are your numbers that there is a problem. The only problem is people wanting a bigger profit and seeing the CS as a pocket they can dip in to.

      • Anonymous says:

        Precisely, and well said.

        What seems to be ignored is the fact that there are two distinctly separate issues here, namely that of the HSA and that of CINICO.

        As far as I am aware Canover Watson’s responsibility and charge is purely related to the HSA . If that is turning a profit, as he has recently stated, then what is his issue with the Civil Service?

        The reason the Civil Service has to use the HSA is purely because it mandated by CINICO, and they are not allowed to use anyone else locally or overseas unless expressly approved by the CMO.

        If indeed CINICO is also making a profit, then what is his beef ?Unless of course he has been appointed also as Chairman of CINICO without the public’s knowledge and wants to combine the two roles?

        Could it be also that the Civil Service as the usual beating stick is being used to fuel political aspirations?

        Let us examine instead who uses the HSA free of cost such as indigents, and those deemed so and see where that money is going. An accounting examination of those who came here from overseas ( with no Caymanian connections) having serious medical conditions in the past 5 years, and were treated by the HSA or referred elsewhere would be a more meaningful analysis.

        As a professional accountant such an analysis should be a piece of cake for Mr.Watson and it should be a public document. Only then will light be shed on the real issue.

  6. Anonymous says:

    Pay towards Health Insurance and then only be given the option of George Town Hospital… I think not !!!!!!!

    To those in the private sector your Health Insurance allows you the option of choosing where you use it, so there is a stark difference here.

    Dont tell CS they HAVE to pay up and then dictate the only place it can be used is HSA!!!!!!!!!

    More importantly, here we go again, throw out more cuts that the CS must take SO the govt. can HAVE MORE MONEY to spend…. cause they sure are not making any cuts in their spending.

  7. Anonymous says:

    the real issue is that the civil service is over staffed, over paid, underperforming and inefficent… the miller shaw report!

    • Anonymous says:

      Correction anon 12:44 the CS is too large and hence costs too much money, it covers too many responsibilities, is underperforming, is too inefficient but is underpaid. You want to make money you work in the private sector not government. Dont consider the elected members as CS they are not.

  8. expat weirdo says:

    If someone is going to choose a low wage in order to serve the government, why should they not be entitled to free health care? Maybe I am missing something.

    At least have a scaling rate. Anyone earning less than $25000 a year gets free coverage, anyone earning 25-35k has to pay half, anyone earning over 35k gets free coverage.

    This is ridiculous. I feel for all the poor families here.

    And enough of this nonsense that the government cannot afford it. The government here probably makes far more than similar sized governments with a population of $50000. Have you seen the price of real estate here? 7% of that is a transfer fee. Not counting the high work visa fees.

    And no I am not a civil servant. But everyone deserves to be covered medically.





    • Anonymous says:

      Your missing a lot.
      Free to them means not free for all those that end up paying for it which is everyone else. Its not free and it is costing more than CIG could ever afford to pay.

  9. Anonymous says:

    Reading the comments so far, it looks like many of the Civil Servants are still living in a dream world with the thought the Government has a very deep pocket.

    Come on- ther is a word called bankcruptsy. Should that happen, they will all loose their jobs. The Government of the day can use the opportunity to downsize and re-hire only to sustainable levels.

    I would imagine , it makes more sense to agree to changes before it gets too late. Just see what is happening around us in the world economies. It will probably be a wake up call.

  10. Anonymous says:

    I Have to wonder sometimes if these people ever heard of the word Law Suite becasue if Mr. Watson and any one else feel that they canjust  break people contract  as they like go straight ahead .

  11. slowpoke says:


    This is the level of understanding of
    medical economics and human behaviour by the Chairman of the H.S.A.?  Pathetic. 
    Why would we want to continue to emulate the US medical system, when it
    is by far the most expensive in the world with substandard results?

    Instead of getting more people to have
    co-pays, limits, deductibles, etc. we should be focusing on getting a comprehensive,
    primary care, not-for-profit program, for all Caymanians and legal residents.   Having a single insurance provider (not
    necessarily Govt.) is the only way to manage costs.  Private insurance companies have an
    obligation to make profits for their stockholders.  Also, by diving up a small market, they are unable
    to negotiate effectively for services here and overseas.

    So, what happens when you increase payments
    for health care?  Low income earners
    avoid or delay getting care.   So,
    instead of getting that “little lump” looked at and removed in day surgery,
    they wait.  Then, when things are much
    worse, they require intensive (expensive) surgery, hospitalization, chemotherapy,
    radiation in Miami…  This of course, also
    leads to loss of employment, family disruption, social costs, etc.  Medical bills are the number one factor for personal bankruptcy in the US – let us not go down that road. 

    We need to look at all the models of health
    care provision, instead of just moving to the lowest common denominator option.

  12. O'Really says:

    Expecting an employer to honour the terms of a contract can hardly be termed a sense of entitlement.

    But what happens when the employer is forced to admit that it can no longer afford to meet the existing terms? In the private sector, employees faced with this have no choice but to make sacrifices or find alternative employment, not easy in the current climate.

    Government is different. They have the choice of imposing new or higher taxes on the general population to cover their shortfall rather than insisting that their employees make sacrifices. Whether the CS has an entitlement attitude or not will depend then on whether they think the solution is to put their hand in their own pocket ( by accepting benefit cuts or making health insurance contributions), or into mine ( through increased taxes in some shape or form). I’ll watch with interest.

    • Anonymous says:

       How about keeping it as it is and stop letting all these new projects in duty free putting a 15% duty on everything no more duty free all companies do with duty free saving is make more profits for there big bank accounts and take the power to make money out of the banker hands.

  13. Corruption or Contagion says:

    It seems like there are 2 major issues here:

       1. An inefficient, unregulated and uncontrolled health Care System that siphons off money through incompetence (very convenient) and direct payments to valueless connected or redundant entities.

       2. A Civil Service that is partially remunerated in the form of total lifetime health care.

    It might be difficult to restructure the CS contracts, although if the government can force a pay-cut it might be able to reduce salaries again by forcing a co-pay agreement. It sounds like there is room for discussion. In any case I don’t think this is the real issue here. Most Civil Servants don’t make all that much money even if you include health care costs. There might be more CS employees than we can afford, but that’s another subject.

    The focus on the CS health care costs is a red herring raised to distract us from the real issue. The comment about the CS being the largest voting block in Cayman is another red herring.

    The reason why the CS is handled carefully is not votes but complicity. By giving the members of the CS an apparent free ride on "Benefits": health care, government gas, underperformance, overstaffing, social staffing, generous retirement and a host of other perks, and by placing restrictions on free speech, they are roped into a system that never criticizes or exposes the corrupt practices that extract vast amounts of money from the public purse and that is where all the vested interests are hiding.

    Making the CS complicit via "benefits" instead of a straightforward salary keeps it quiet. Without a doubt everyone in the CS is aware of how the system works and who the players are but if they open their mouths they will lose their jobs and all those slippery “Benefits”. The rest of Cayman is also compromised though licenses, permits, contracts, dependency on influence and possibly as direct beneficiaries of the public monies that spill out of every seam in the system. Anyone left out can apply to Social Services. So nobody rocks the boat.

    The sad part of this story is that the Civil Service is staffed by very good and honest people, I can honestly say that many of the finest Caymanian I know are employed in the CS and they don’t like the system at all. Ask them a direct question and they shut their mouths, but the knowing look in their eyes tells a lot. Since the CS knows where all the leakage and skeletons are hidden they are our best chance for change. It would be nice to see real reform come from that direction.

    Does anyone know if a FOI request can be made that exposes all of the “middlemen” involved in the government health care system and how much they have been paid over the life of their arrangements or is that outside of the FOI law?


  14. Anonymous says:

    i actuallly agree that civil servants should pay a monthly premium for health care. however we are so poor at the moment to deduct even more from us would be crazy. why not give us back our 3% and deduct 2 % for coverage?

    • Anonymous says:

      Think your poor now? Just wait until there is no more loan money and even less coming in. Unless there is a miracle there is no way this will not happen. But be happy, listen to your Premeir tell you eryting be aight as he gets on his airplane but close your eyes tight against what you might see if you looked for yourself. There are many like myself who will be happy when this day comes because we can see the future and those who can actually make a living by themselves will get whats left.

  15. Anonymous says:



  16. Anonymous says:

    Many long serving civil servants have taken a reduced salary in comparison to what they could have made in the private sector because of the benefits/value of free medical. It is therefore not fair or legal to take away from them what they signed on for in their employment contracts. Now for new persons entering the civil service there should be no problem in changing the rules ie. from a certain date say that all new civil servants will have to pay/contribute to their health care.

    • Bozo says:

      But in your way of thinking it is fair that those who work in the private sector with its lack of benefits pay for ALL of the benefits of those who now work for Premeir Bush’s Government.  The very root of Caymans problems is the "I am intitled to my share of the publics purse" mentality.

    • Real T Check says:

      Many long serving civil servants would not survive in the private sector because they have to actually work for their pay!!! 

    • Anonymous says:

      Is Canover Watson also suggesting that civil service retirees also contribute?

      We hope not, because these retirees earned far less in the old days, with the promise of benefits in later years when they needed them such as medical.

      I believe he has put his foot in his mouth with his comments.

      • Anonymous says:

        Mr Watson is dooming the Government Hospital by his comments. It is true that the CS gets there health paid for them and this is not right. But the greatest travesty is not that fact but simply that the CS has to deal with the Government hospital because that’s where CINICO is taken. You want the CS to pay then you cannot tell the CS that they have to deal with the Government hospital.


        I am so impressed with these head of boards, especially one that represents one of the greatest leaches on the Cayman Islands in the first place. Does anyone ever remember the Government hospital showing a profit except in recent times when they have doctors the numbers.

  17. Anonymous says:

    Who is Canover Watson to question what is a valid contract of employment between the Civil Service and its employees? He should instead focus his energy on cutting the waste that exists within the HSA and the inefficiency. An example is why is’nt there an answer to many of the extensions such as General Practice irrespective of when one calls.

    He also needs to be reminded that there is no type of annual bonus paid like that of the private sector he is used to. The private sector employees can therefore afford to contribute.

    There is no culture of entitlement as he suggests, but rather it is a valid part of every civil servants pay package that they agreed to from the outset with their employer. If there is a change to the conditions of contract then there must be raise in salary to offset the loss as part of their package. Civil Servants cannot take any more pay cuts, and must no longer be the beating stick.

    Canover Watson is acting outside of his remit.


    • Anonymous says:

      i work for a statutory authority of government my pay is really low i get no bonus and i have to pay for my health care insurance also that of my dependants…

      • Anonymous says:

        That maybe so, but I am sure that you are not forced to use the HSA? If we must contribute then we need to have a choice. Canover Watson cannot have his cake and eat it too. XXXX

  18. Anonymous says:

    Hey Canover.

    When I went to work for government, no one asked if I would be willing to pay for part or all of my health care.  I was told it would be paid for.

    Since I have worked for government, no one has asked if I would be willing to pay for part or all of my health care.  It has simply been paid for.

    Before you start whining about some alleged "entitlement behavior" on the part of civil servants, why don’t you get off your butt and work with government and the civil service to address the issue?

    By the way, while you are up, can you let us know where the $100 million  in unaccounted-for payments (over two years, as reported earlier on CNS) to HSA went?


    • anonymous says:

      The entitlement behavior of civil servants is because they actually are entitled.

    • noname says:

      The 100 million went to those who were entitled to it more than those who were promised it.

      • Anonymous says:

        $100 million?  And how many people are entitled to that amount of money?  5?  10?  $100 million is a hell of a lot of money and if I give it to you as a business transaction and you cannot tell me what you have done with that money, then…

        that is piracy.

  19. Anonymus says:


    Having the opportunity to attend the meeting yesterday I’d like to add a few things to this article.
    1)      The conference was geared at selling a ‘health management system’ to the Cayman Islands.
    2)      As Mr. Watson himself had to admit, he was inaccurate in attributing his ‘entitlement culture’ to civil servants and not the HSA-using public as a general whole.
    3)      Interestingly, calls for ‘sacrifice for the greater good’ were actually a call to sacrifice Civil Servants, not sacrifice to take care of people. The bottom line, for presenters and many participants, was to put more money in the pockets of the HSA/CINICO and their private sector partners while reducing coverage for people.
    4)      I would be interested to hear from Ms Yearwood et al what ‘dialogue’ they would ‘like to keep going’? So far, if yesterday’s forum was anything to go by ‘dialogue’ is code for ‘we tell you what we want to do to make more profit’. (And, yes, this includes HSA & CINICO.)
    5)      One interesting rumour going around the Forum was that CINICO has recently kicked out its plan administer (note, this rumour did not come from the person themselves, but from other people) so suggestions from private industry middle-men to ‘cut out the middle man’ are, frankly, not going to get very far at this time.
    I found it interesting to note that you closed on the anti-health-care quote by the host and not his observation that the country should be moving towards a nationalised, i.e., 100%, coverage. Clearly you got the message that the Forum was trying to deliver: the time of suitable health coverage for the people of the Cayman Islands is rapidly ending. If you’re not independently wealthy and you get a significant medical condition, e.g., organ transplant or long term intensive care, you’d be better off killing yourself because otherwise you’re going to beggar yourselves and your family and the Government has no interest in looking out for you. Even if you have, like the Civil Servants (especially the retirees) being targeted, given the Government or the country decades of service. But just as dialogue is no longer a two-way street apparently neither is honouring your employment agreements or the social contract in general.
  20. Anonymous says:

    Finally some sense being spoken – now whether there will be any backative….

    • Anonymous says:

      Backative !

      What is that ? Just cut out the waste such as Hurricane Hilton in Cayman Brac.

  21. Anonymous says:

    No problem with that as long as we are free to go to private practitioners!