SINT MAARTEN (GREAT BAY) - The Soualiga Employers Association (SEA) is expressing serious concern regarding the projected deterioration in the financial position of the health and social insurance funds administered by the Social & Health Insurances (SZV).
Recent projections contained in Government’s 2027 budget indicate that the combined reserves of the ZV, OV, FZOG, AVBZ and OZR funds could decline from approximately Cg 279.8 million in 2025 to Cg 178.3 million by 2029, which implies a reduction of more than Cg 100 million. The projections also indicate continuing annual deficits, increasing from approximately Cg 19 million in 2025 to Cg 28.8 million by 2029.
For SEA, these figures warrant urgent and deliberate policy attention. The issue should not be viewed simply as a matter of the level of reserves at a particular point in time. The continued structural deficits indicate that the underlying financing and expenditure framework requires meaningful intervention if the sustainability of the social insurance system is to be preserved.
SEA recognizes that Government has identified the implementation of a National Health Insurance (NHI) as an important strategy towards addressing the long-term sustainability of healthcare financing. SEA has previously expressed the view that, while NHI may be an important component of the solution, it cannot, on its own, guarantee the long-term sustainability of the healthcare system and must be complemented by other structural and policy measures. Considering the magnitude and urgency of the projected challenge given our increasingly aging population, SEA therefore believes that additional complementary and supporting measures to NHI, must be developed and implemented somewhat simultaneously and in a timely manner.
The objective should be to ensure that Sint Maarten has a healthcare and social insurance system that is financially sustainable, provides appropriate protection to the population, and does not place an increasing and potentially unsustainable burden on employers, employees or public finances.
Without prescribing a single solution, SEA believes that Government should urgently consider a comprehensive package of measures to address the structural challenges facing the social and health insurance system. This should include accelerating healthcare financing and structural reforms, including the timely development and implementation of the National Health Insurance framework along with its complimentary measures, while also reviewing the contribution and financing structures of the various social and health insurance funds to ensure that revenues remain aligned with their obligations. Some of the complimentary measures inevitably would revolve around the stimulation of the economy, as a means of income growth and a vibrant working population.
At the same time, greater emphasis should be placed on healthcare cost containment, including procurement, pharmaceutical expenditure, specialist care, referrals and other significant cost drivers. Strengthening preventative and primary healthcare should also form part of the reform agenda, with the objective of reducing avoidable illness and the need for more costly interventions.
SEA also considers it important to strengthen actuarial forecasting, financial monitoring and accountability, supported by regular reporting on the long-term financial position of the various funds. Particular attention should be given to the implications of Sint Maarten’s changing demographics, including an aging population and the relationship between the number of contributors and beneficiaries. Measures to improve compliance, reduce leakage and ensure that all parties appropriately meet their obligations should likewise be pursued.
SEA encourages Government to establish a structured and inclusive dialogue with employers, employees, healthcare providers and other relevant stakeholders as reforms are developed. Such engagement can help ensure that proposed measures are practical, balanced and sustainable, while also building greater understanding and support for the changes that may ultimately be required.
SEA therefore calls on Government to treat the projected financial trajectory as a matter requiring immediate policy attention and a clear, time-bound reform agenda. The Association stands ready to participate constructively in the national dialogue and to contribute the perspective of employers to efforts aimed at securing the long-term sustainability of healthcare and social protection in Sint Maarten.
