General Health Insurance draft legislation at Council of Advice | THE DAILY HERALD


~ VSA, PAHO to hold community stakeholder consultations ~


PHILIPSBURG–The Ministry of Public Health, Labour and Social Affairs VSA in collaboration with Pan American Health Organisation (PAHO) representatives will be engaging in community stakeholder consultations on the General Health Insurance (GHI) for St. Maarten.


  The legislation is currently at the Council of Advice. With PAHO’s support, the VSA Ministry is preparing to educate various community stakeholders on what the general health insurance will mean for them and how the legislation will affect the health care system in St. Maarten.

  “We expect that advice to be completed by the Council of Advice in March, in which case we then need to respond to it and then it goes to Governor and begins its legislative track,” VSA Minister Emil Lee said during the Council of Ministers press briefing on Wednesday.

  “The General Health Insurance legislation we have, I believe it is transformational. If you look around the world, it has been battleground legislation.

  “It has been something that is contentious within the community, the haves and haves not – the people who have access and the people who don’t. The people who think they take care of themselves, the people who have other illnesses.

  “There is a very personal discussion in terms of how we finance health care and we believe that we have come with a very good legislative piece in terms of how to address that.”

  Lee elaborated with a true story of how the current health care system fails the average resident and outlined the alternatives that are in fact not to the benefit of the resident or Government.

  An example of challenges faced with current health care system is “a married couple where both parents are working. The man is doing a great job and gets a promotion; this promotion means that financially he would be just over the SZV wage limit.

  “As he is the breadwinner, all of his children fall under his SZV insurance as dependents. Because of his raise, the entire family, excluding the wife who has her own insurance via SZV, have to now find private insurance.

  “The problem now becomes that one child has a chronic illness that is seen as a pre-existing condition and private insurance companies would either not cover this or put a lifetime limit on the coverage which can quickly run out as a result of chronic illness.”

  He said undesirable alternatives to solve the problem are: “The father can deny the promotion and remain under the ZV limit and then remain insured, which lots of people choose do. The parents can get divorced and the mother gain custody of the kids and then her insurance would cover the kids, or come to government for assistance thereby government paying for the child’s chronic treatment – government thereby pushing the boundaries to do the right thing.”

  “Something is fundamentally wrong with our system when we have these types of stories.

  “If you are a sole proprietor, you also have a challenge in accessing health insurance.

  “We have too many issues; we need to come with a unified system where everyone pays for their fair share and everyone can have access to health insurance. I believe the legislation makes the system more efficient, more effective, and more equitable and I believe also financially sustainable.

  “In the long run, as we look at our health care costs, it is in every country a high expense in the budget and I believe, again, that with General Health Insurance, we have a system that is financially sustainable, but it does require some changes in the community. But unfortunately, we have some people, they say they want the change, but they don’t want the change to affect them directly.”

  The PAHO team will consist of two groups, coming to St. Maarten in March and April. Some of the representatives are Director of Health Systems and Services Dr. James Fitzgerald; Representative of St. Maarten and Regional Director for the Dutch Caribbean Dr. Erica Wheeler and Public Health Economist Dr. Stanley Lalta.

  The latter brings with him a wealth of knowledge and experience. He has been very instrumental in getting the General Health Insurance to where it is now and he has years of experience helping other countries do the same. The PAHO team are third-party experts on this topic.

  “We are not unique in the world. In fact, we are the last to join in a form of universal health insurance in the Kingdom. We have the benefit of learning from the others of what they did right and what they did wrong and again we are bringing in health professionals to help explain this to our stakeholders within the community,” Lee said.

  Persons who are interested in hosting or having a community or group stakeholder consultation with the Ministry and the PAHO representatives can contact the Department of Public Health via e-mail at

[email protected]

  “What is Universal Health Insurance? In a nutshell: in our governing programme – one of the objectives is to ensure that everyone has access to quality health care close to home, while we are working on transforming our health care system with the new hospital, our referrals system that’s being revised completely, looking at our prescription drug programme, looking at the relationship between SZV [Social and Health Insurances – Ed.] and the care providers.

  “All of these are things that are happening parallel, but we also need to look at how to finance our health care system and who has access to our health care system – how does that actually work? … I would like to give a big thanks to PAHO for assisting us,” Lee said.

Source: The Daily Herald