Please allow me some space to express my opinion on the seperation of "cure" and "care".The two main pillars of a society are "Education" and "Healthcare". It is proven that healthy educated people are more likely to be able to take care of themselves, are more productive for the society and are less likely to be involved in crime. The quality of life in countries with a high quality affordable well functioning healthcare system is extremely high compared to countries where there is a low level of education and a low level of health care. On Sint Maarten we are so focused on immigration, crime and finance that we seem to forget about one of the most important pillars of our society.
Civil servants and others are working hard behind the scenes to introduce a compulsory health insurance in Sint Maarten. We already saw the establishing of the Uitvoeringsorgaan Sociale en Ziektekosten Verzekering (Social and Health Insurance-SZV). The main points of focus for restructuring our healthcare system should be:
- Better streamlining of primary, secondary and tertiary care
- Financing of the healthcare system
- Prevention
- Education
- Compulsory health insurance
- Restructuring the tariff structure
- Restructuring administrative procedures
- Establishing who will administer the health insurance
- Establishing a basic coverage package
- Determine needs for care and facilitate for this need
You can divide healthcare in "cure" and "care". Cure is when someone is sick and needs treatment to get better and care is for those who will not get better. You can think about persons suffering from chronicle illness, mentally challenged persons, handicapped persons. Of course, our elderly need a lot of "care". The "care" part falls under the AVBZ.
The AVBZ (Algemene Voorzieningen Bijzondere Ziektekosten) has been a federal decree since 1996 in the former Netherlands Antilles (PB 211-amendments have been made a couple of times since then). The Central Bank of the former Netherlands Antilles monitored the funds, while BZV dealt/is dealing with the operational part of the fund.
With the setting up of a compulsory health insurance comes the intention to include "cure" and "care" in the same basic coverage package. I disagree with this.
Without going into detail, the current basic coverage package is based on a Dutch model. The Dutch always made sure that they separated the "cure" and the "care". Even though the insurance is compulsory, it would not compulsory for persons who are earning above a still to determine amount (like the former SVB). How and to whom are the private insured patients paying their contribution into the "care"? The financing of the compulsory health insurance would be that there are is a higher collecting of premiums compared to costs in the beginning than in fifteen years due to the faster rise of healthcare costs than the rise of wages. So, you will create a reserve to compensate for the years that the costs are higher than the collected premiums. This by itself makes perfect sense.
However, Korsao has got about 23 AVBZ institutions or institutions receiving money from the AVBZ fund and Sint Maarten 3 (Sr. Basilia Center, White & Yellow Cross and Mental Health Foundation). Over the years, there have been a great under consumption of the AVBZ fund by the Sint Maarten population. A valid reason for people not to make use of these funds is that they have to go to Korsao. An island where they might not have family and don't speak the language. So, people rather stay without extra help or revalidation on Sint Maarten and rely on the help of family and friends.
Looking at the above stated, you might conclude that Sint Maarten is in need for an expanding of our AVBZ institutions or even create more AVBZ institutions. This will cost money. Should this money be used out of the same fund from which the "cure" costs are being paid? No!! Two separate funds are needed and if one fund needs more money to cover certain costs than it is governments duty to look for additional monies elsewhere.
Have a great day,
Sjaoel "Shooz" Richardson
