New HealthServices Fees and System for Better Care
In order to continue providing high qualityhealth service, the Cayman Islands Government has begun introducinghigher fees at all Government Health Care facilities, includingFaith Hospital on Cayman Brac and District Health Centres
The move to this average 30 per cent raisein charges is part of government's revenue measures announcedrecently by the Financial Secretary, Hon. George McCarthy in the2002 Budget presentation and the first set of increases took effectfrom 11 January and another batch of fee hikes will begin on 1April.
In explaining these fee increases the HealthServices Department said that over the past years, a significantamount of money has been spent to upgrade staffing levels, andthe physical facilities at the Cayman Islands Hospital, FaithHospital and district health centres as well as to bring the levelof service to international standards.
At the same time the cost of providing theexcellent quality of health care, which Caymanians have been accustomedto, has escalated significantly. However, there has been no increasefor the past eight years in the cost of obtaining the qualityhealth care services delivered at these health facilities.
While the Government is projecting to spendin excess of $44M in recurrent expenditure to provide health careservices in 2002, the current charges for these services are reportedto be far below actual cost and what is required to provide qualityhealth care services and maintain the facilities at current levels.
The fee increases are being phased in tobring current charges to more realistic levels over a period oftime, while administrators are in the process of improving systemsand procedures to ensure that the cost of health care remainsaffordable to the public.
The new fees will be applied to most patientservices, including doctors consultations, dental and eye examinations,accident and emergency and in-patient services. New services,which were introduced since the last Fees Law (1993), and forwhich no charges previously applied, now attract a fee.
On Cayman Brac, for services provided atFait Hospital, a Caymanian ordinarily resident in Cayman Bracor Little Cayman is liable to pay fees at 50% of the rate specified.This reduction in fees does not apply in respect of a person whois covered by health insurance which would otherwise cover thewhole cost of any service provided at Faith Hospital.
Payment of fees throughout Cayman may bemade by cash, personal cheque, valid credit card, valid healthinsurance coverage, with written referral if necessary.
Also included are new charges to serviceswhich were previously provided at no cost. Many of them were introducedsince 1993 to provide a comprehensive range of patient care. Theywere provided at no cost to patients because these services werenot included in the Fees Law. The new Fees Law, which has beenapproved by the Legislative Assembly, now requires that a feebe paid for these services.
All fee increases this year apply to appointmentsscheduled prior to 1 January.
All payments must be made at the point ofregistration. And, in cases where the doctor determines that additionaltests or services are required, the charges for these must bepaid before the tests or services can be provided.
All insured patients will be required topay the insurance deductible prior to services being rendered.Where an insurance claim is less than $25, the patient must paythe amount in full at the time of registration, e.g. for injectionand dressing.
Patients are responsible for all financialliabilities including co-payments, deductibles and out-of-pocketexpenses at the time of registration or at the time of dischargefor emergency admissions. If the exact dollar amount has not beendetermined, you will be asked to pay the estimated amount andwill be billed for the remainder. Patients are required to payany excess on their insurance cover.
The Health Services files insurance claimswhere applicable, but the prompt and full payment of the accountremains the responsibility of the patient.
Although the Department may accept paymentdirectly from an insurance company, any amount billed but notpaid by insurance is the patient's obligation. Health insurancecontracts are agreements between the insured and the insurancecompany. Patients are asked to pay the remaining balance and contacttheir insurance companies if they believe there is an error withthe claim.
Patients will be asked to provide insuranceinformation such as the name of the insurance company, the billingaddress and telephone number, current subscriber name, certificateand/or policy number and effective date of plan.
It is very important that persons seekingmedical care can provide accurate information so that insurancecoverage can be verified. Most of this information can be foundon their insurance I.D. cards, which should be brought at thetime that the care is sought. The blue registration card is alsorequired at that time.
All insured patients will now be requiredto submit a photo identification with their insurance cards atthe time of registration. All information will be checked to verifythe identity of the insured; the validity of the card and thelevel of coverage provided before service is given.
Patients should note that it is importantto check the details of insurance coverage and the level of benefits,which would tell them exactly what they are entitled.
Photo identification is being used to protectpatients' rights and privileges and to verify the legitimacy ofthe person presenting the insurance card. It will be necessaryto present a photo identification, which is one of the following:a passport, Government department photo identification, a driver'slicence or a Voter Registration Card.
In the absence of such identification, noone will be denied emergency medical care at any Government facility;however, in non-emergency cases the appointment will be rescheduled.
Advance notification of at least four hoursfrom the scheduled time is required in instances where patientsare unable to keep an appointment.
In circumstances where a patient is unableto pay, that person will be given a new appointment date. A FinancialCounsellor will also be available to meet that individual to determinethe person's financial status and arrange a suitable method ofpayment.
Whenever required, a Financial Counsellorwill meet patients to determine their ability to pay for the treatmentor services required. The assessment will take into account theirtotal disposable income and the total value of any assets thosepersons or their spouses may possess.
If the condition of patients is deemed anemergency, they would be provided with medical care and paymentarrangements will be discussed afterwards. However, for non-urgentcases, the Health Services Department will work with them to arrangea suitable date for a new appointment, when they are able to pay.
These new rules apply also to persons beingadmitted as private uninsured patients. They will be requiredto pay a security deposit prior to their admission and any balanceon discharge. The Patient Financial Services Unit will advisesuch persons of the deposit required and the amount due. Thiscost depends on the medical care procedure and the length of stay.
If a patient's employer is paying part ofthe medical expenses, the employer would be required to providea letter indicating consent to pay part of those medical expenses.It is important that the patient notes that the authenticity ofthis letter will be verified with the employer. The patient will,however, be ultimately responsible should the employer not honourthe commitment.
Non-payment of outstanding accounts mayresult in patients being denied some future hospital services.The Department is advising patients with overdue accounts to contactthe Financial Counsellor making that health officer aware of thesituation and work out a payment arrangement.
As in the past, certain categories of patientsare exempted by law from paying medical fees at government facilities.
No modifications have been made to this.
These categories include:
(a) a public officer or the spouse or adependent of a public officer (but only to the extent providedin the terms of employment of the public officer);
(b) a member of the Cayman Islands Veterans Association, aged55 years or older at the date of requesting treatment or the spouseof such a member;
(c) a member of the Veterans' and Seamen's Society of Cayman Bracand Little Cayman, or the spouse of such a member who satisfiesthe conditions specified in subsection (2) of the Health Services(Fees) Law (2001 Revision). The patient, or if the patient isthe spouse of the member, the member must produce written evidenceof having been a merchant seaman for a continuous period of atleast three years beginning before the 31st December, 1984;
(d) a member of the Cayman Islands Seafarers' Association, orthe spouse of such a member, who satisfies the conditions specifiedin subsection (2) of the Health Services (Fees) Law (2001 Revision).The patient, or if the patient is the spouse of the member, themember must produce written evidence of having been a merchantseaman for a continuous period of at least three years beginningbefore the 31st December, 1984;
(e) a person receiving a public office pension from the Governmentor the spouse of such a person;
(f) a patient who is being investigated or treated for AIDS, tuberculosisor malaria if so certified by the Medical Officer of Health; or
(g) a prisoner as defined in the Prisons Law.
Exemptions are also made for indigents,legislators and students.
All categories of individuals listed aboveare required to produce an identification card at any of the GovernmentHealth care facilities to receive the benefits of such exemptions.
The exemptions and waiver of fees do notapply in cases of a person who are covered by health care insurance,which would otherwise cover those fees, to the extent that suchinsurance cover is in force.
Below can be found a listing of the newcharges for the most commonly used service.
A copy of the Health Services (Fees) Law(2001 Revision) and Health Services (Fees and Charges) Regulations,2001 can be obtained from the Legislative Assembly for a minimalfee, or see the Cayman Net News editions 143 and 144.
New Charges
Hospitalisation (including room, routinemedical and nursing services) Semi private or multi-bedded areaper day C.I.$300
Private room per day C.I.$425
Intensive Care per day C.I.$1,370
Maternity Delivery C.I.$450
Maternity hospital care - per day C.I.$325
Neonatal care - (normal) per day C.I.$350
Neonatal care - (intensive) per day C.I.$1,370
Consultation
In-patient physician's fees C.I.$65
Clinics (during scheduled hours)
General Practice Physician Clinic C.I.$35
Referral: Appointment with specialist C.I.$50
Emergency Room (excludingdrugs)
Level 1 C.I.$80
Level 2 C.I.$130
Level 3 C.I.$325
Injection C.I.$13
Dressing C.I.$13
Ambulance
Emergency C.I.$130
Transfer C.I.$100
Escorting Patient to Overseas Institution
Full Cost to be Paid
Dental Services
Examinations
Oral examination (full examination) C.I.$40
Specialist consultation / examination C.I.$65
Ophthalmology
(Eye Clinic)
Consultation - Specialist C.I.$50
Administrative Services
Arrangement of overseas referral for nonresident C.I.$450
Replacement of registration card C.I.$15
Special Services
For Laboratory, Radiology, Pharmacy, Medicalsupplies, Physiotherapy and procedures conducted at our SpecialistClinics, fees will be calculated according to the services provided.
Persons with any further questions, callGeneral Practice 244-2800, Dental Clinic 244-2741, Eye Clinic244-2818, Specialist Clinic 244-2530/1.
For questions about payment and FinancialAssessment call 244-2589 or 244-2828.
For questions about the provisions of yourinsurance and coverage please call your insurance company.
For all other enquiries call: 244-2816