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St. Maarten government will set new medical tariffs only if public health compromised


~ Head of Public Health Fenna Arnell speaks out on private insurance card ban ~

PHILIPSBURG–The continued non-acceptance of private medical insurance cards by private practitioners is “undesirable” and “unfair” to patients who are the ones hurting, says Public Health Head Fenna Arnell. Windward Islands Medical Association (WIMA) family practitioners stopped accepting the cards as of September 27, 2012, after WIMA could not reach an agreement with the St. Maarten Insurance Association (SMIA) for cost-of-living adjustment (COLA) payment. To date there is still no agreement.

Arnell said government had been urging the parties to come to a speedy resolution and would intervene and set new tariffs only if “public health is compromised.” “In the long run the ones suffering are the clients,” Arnell told The Daily Herald. “And considering the fact that we have a high population of chronically ill persons who suffer from diabetes and hypertension, this situation is actually leading to a blockage for persons being able to go to health care providers when necessary.” “Can you imagine if it’s the 20th of the month and someone has no more money and is waiting until they get paid and their child who is asthmatic needs to go to the physician? What is that person going to do?” she said, giving an example of what some persons may be going through. “This is something that we think should be solved very quickly.”

Arnell said government had intervened in the mater late last year when the ban went into effect and had met with both sides at least five times since then, in addition to numerous emails encouraging parties to come to a speedy resolution. She said that while government could step in and set new tariffs to cover the privately insured, this would have serious consequences for the 30 per cent of the population who are uninsured (not necessarily undocumented), as they automatically would have to pay more for medical consultations.

“If they [SMIA and WIMA – Ed.] really can’t come to a compromise, then government would step in and set a tariff. Enough would be enough when we realise that public interest is being compromised,” she said. “The department has been struggling with the decision of whether or not to increase the tariffs across the board, because we don’t want to make it difficult for especially those persons who are unable to obtain private insurance and therefore remain uninsured to pay the higher tariff out of their pockets.”

Cards not being accepted since September 27, 2012, are NAGICO, ENNIA, Fatum, Sagicor and Alico. Cardholders are required to pay cash up front and are given receipts to claim repayment from their insurance companies, but WIMA says some patients are not claiming back their expenses, resulting in massive savings for insurance companies at the expense of patients. Tariffs  Several ordinances are in place regulating tariffs for medical cost.

One, for example, covers ZV/OV (sickness and accident) insurance for Social and Health Insurance SZV, which is for persons employed in the private sector who earn up to a certain salary level and who work for a certain number of days. Another regulates civil servants (BZV) and another covers persons who have private medical insurance. NAf. 38 per person per consultation is the current maximum tariff for the latter category, which means that the tariffs cannot exceed this amount. An article in this ordinance gives insurance companies the possibility to negotiate outside of this tariff, which is the clause being used to urge parties to negotiate.

Arnell said the category of persons who are self-employed, such as bus drivers, food vendors and cleaners, who have work agreements with individuals and not with companies, and who would have to secure their own private medical insurance “are the ones whom we have to think of because they are paying out of their own pockets.” Private practitioners are requesting that the tariff be increased from NAf. 45 (US $25) to NAf. 56 (US $31), which they contend is to cover inflation, correcting the primary care tariffs unchanged since 1999.

Head of Public Health Fenna Arnell Arnell’s advice to WIMA and SMIA is to “remember what it is and who it is you are serving. You are serving the public and your clients, and the clients are actually the ones suffering. Their (WIMA’s and SMIA’s) personal interests are being put in front of the needs of the clients whom they are actually there to serve and protect.”  At the moment house doctors are charging patients US $31 or NAf. 56 per consultation. Patients who claim back their payments are reimbursed only NAf. 45, which is what the ordinance stipulates, so patients lose in the end.

Health Minister Cornelius de Weever had said last year when the ban went into effect that the Public Health Policy Department had been in the process of finalising a new tariff structure that would have included services rendered by general practitioners, in which inflation would have been taken into consideration. This tariff structure, which was established based on the principle of equal access, had been developed in collaboration with the various health care providers, including the general practitioners, but did not go into effect due to concerns that it would affect the current uninsured population, Arnell said. “For example, gas and/or diesel price is not determined based on the model of the car, but on the amount of litres requested by the driver at that moment.”

Doctors who are not accepting the private insurance cards are Dr. A. Arrindell, Dr. P. Arrindell, Dr. Bouman, Dr. Bus, Dr. Datema, Dr. Deketh, Dr. Dennoui, Dr. Douglas, Dr. Foeken, Dr. Herles, Dr. Knol, Dr. Mercuur, Dr. van Osch, Dr. Perez, Dr. A. Raghosing, Dr. Simmons, Dr. Spencer, Dr. Swanston and Dr. Tjaden.  Arnell said it was imperative that parties try to come to a quick solution. “We have been facilitating the process for physicians and the insurance agencies to come together and come to an agreement on what tariffs will be applied to privately insured clients. As a ministry we have to look across the board. “The physicians are saying that on an annual basis the insurance companies increase their premiums and that they should also increase their payment to physicians. The insurance agencies say, ‘Yes, but health care costs on a whole have increased so we have to ensure that we can balance it off.’ It’s something that they have to try to work out. Unfortunately it’s taking very long.”

Arnell said that when the government first was approached on the matter in May 2012, it had informed parties that while it made use of Article 1(2) of the decree regulating tariffs for general practitioners to increase tariffs covering medical cost for civil servants, this same article must be and was being used for the two organisations to negotiate their tariffs among themselves – not for the government to determine what the tariff should be.

WIMA Chairman Dr. Hidde Deketh had told this newspaper that WIMA “fi- nally” had received a proposal from SMIA recently after a year of deadlock and WIMA had returned a counterproposal last week and would await a response from SMIA.  SMIA Chairman Eric Ellis had been off-island and was unable to respond to this newspaper’s queries on the matter last week Friday and Sunday. Ellis has responded since and is expected to comment on the matter.

Source: The Daily Herald, St. Maarten

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