PHILIPSBURG–Interim Minister of Health, Labour and Social Affairs VSA Pamela Gordon-Carty announced on Tuesday that she has decided to discontinue the VSA, Social and Health Insurances SZV and St. Maarten Medical Center (SMMC) tripartite arrangement, as it has completed its objective.
She said the tripartite had been established for the purpose of the construction of the new hospital building that will house the new General Hospital. “Having consulted with the Ministry and with external advisory bodies, it has become clear that the tripartite has concluded its task,” Gordon-Carty said in a press release on Tuesday.
The VSA-SZV-SMMC tripartite was based on a protocol signed in March 2015 between then-Minister of VSA Rita Bourne-Gumbs, SZV Director Glen Carty and SMMC Director Kees Klarenbeek. “The tripartite was not based on a national decree, rather a tripartite agreement, which is an agreement between three parties,” she said. “This protocol established consultations to develop the design of a new hospital.”
Each of the three parties to the protocol had its own responsibilities. The VSA Minister was responsible to develop and supervise the public health policy. SZV was charged with financing health care services for persons insured by social health insurance funds, government PP-card holders and civil servants. SMMC was the private foundation providing hospital services.
The Minister said the International Labour Organisation (ILO) recommends that governments promote tripartite consultations according to ILO standards between employer, employee and government representatives.
She said decisions taken by the VSA-SZV-SMMC tripartite were not based on established legal advisory procedures.
According to the Minister, it was established that the VSA-SZV-SMMC tripartite had taken compromising decisions with far-reaching consequences for country St. Maarten and the public health system. She said this statement was supported by the Council of Public Health, an official advisory body to the VSA Minister, on October 1, 2018, under the title “Tripartite Minister VSA-SZV-SMMC”.
It was reported to the former VSA Minister that the Council had not been approached for any advice in the setting up of such a “tripartite” constellation. Three of six breaches were mentioned on page 3 of the advice provided.
The Minister said the first breach was that the tripartite had decided to increase the yearly advance from SZV to SMMC since 2006 by 35 per cent without going through the normal advisory trajectory of establishing a national decree concerning general measures for new social tariffs for nursing and medical services.
Second, the tripartite had decided to increase SMMC tariffs for the private sector without requesting the required advice to change the current national decree.
The third breach was that SMMC and SZV were decision-makers in this tripartite committee, which is a conflict of interest.
“SMMC and SZV were making decisions on matters concerning themselves, while the interests of other stakeholders were not taken into account,” the Minister said. “It is evident that the former Minister of VSA and the tripartite have made decisions on issues that have far-reaching consequences for public health. These decisions were taken without requesting advice from legal advisory bodies such as the Council of Public Health, the Social Economic Council (SER) and the Council of Advice. “
The Minister said that the Council of Public Health had advised the former VSA Minister to change the constellation of the tripartite and the task of the tripartite into an advisory committee. She said the former Minister had ignored the advice and had not provided a written motivation to the Council before deviating from the advice and continuing the original tripartite constellation.
“Disregarding Article 15(1) of the National Ordinance concerning the Public Health Council is unlawful. Therefore, as the current Minister of VSA, I will inform the Council of Public Health of my decision and my motivation to discontinue the tripartite,” she said.
The Minister said decisions taken by the VSA-SZV-SMMC tripartite had far-reaching consequences for public health. SER in its advice of April 17, 2018, (ref no: SER/18/BP/11) gave a negative advice on the 41.83 per cent tariff increase at SMMC. SER stated in its advice that it did not agree with the indexation of 41.83 per cent and advised the government to recalculate the medical and nursing tariffs before the end of the year 2019.
The Minister noted a statement by SER which said, “The national decree medical and nursing tariffs (AB 2013 GT no. 53) determines that SMMC may not charge a higher fee for medical and nursing services than those agreed upon” on page 3 of its advice. She said SER had expressed concerns, saying on page 5 of its advice that it did not agree with the way the adjustments were being calculated and that the tariffs should be recalculated instead of just being indexed.
SER continued to express concerns by saying, “The SER underlines that if the cost of delivered services is significantly higher than government-approved tariffs, it will have a negative impact on the quality of services as well as on the sustainability of SMMC.
“Any increase, especially an immediate increase of more than 40 per cent will have consequences which may negatively influence the social and economic welfare of St. Maarten, especially considering the effects the passing of Hurricane Irma has on the social economic landscape.”
The Minister said that in various public statements the St. Maarten Consumers Coalition had also expressed its concern about the tariff increases at SMMC and transfers made by SZV, absorbing higher tariffs without an amendment of the national decrees.
“After objectively considering the reports and information received from relevant stakeholders mentioned above, I understand the negative impact of continuing with the tripartite in its present form,” she said.
“On December 27, as Minister of VSA, accompanied by some of my advisors, I consulted the members of the coalition in government and in Parliament about the above-mentioned findings and about my decision to discontinue the participation of the Minister of VSA in this tripartite.
“The fact that the purpose for the existence has also already been realised (the design of a new hospital and a business plan), I have informed the Director of SZV and the Director of SMMC of my decision not to continue the tripartite as agreed.”
She said that government would continue consultations with SMMC and SZV.
“There are existing advisory bodies which have to consult with SMMC as a health care institution and with SZV as the social and health insurances executing agency. Furthermore, I emphasise that any stakeholder in the public health sector is welcome to approach the Ministry of VSA for information or dialogue on improvements of the health care system in St. Maarten,” she concluded.
Source: The Daily Herald https://www.thedailyherald.sx/islands/93817-vsa-minister-terminates-vsa-szv-smmc-tripartite
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