PHILIPSBURG:--- A financial catastrophe is not just brewing in St. Maarten; it has been announced, documented, and repeatedly ignored. For years, the leadership at Social & Health Insurances (SZV) has sounded the alarm, providing clear data and desperate warnings about an impending collapse of the nation's health and social insurance system. Yet, these cries for urgent action have fallen on deaf ears within the government, pushing the country ever closer to a crisis that will affect every single resident.
The facts are stark and unforgiving. As far back as 2022, SZV Director Glen Carty laid out the terrifying reality: the healthcare system was hemorrhaging money, with a deficit of approximately $35 million per year. The warnings were not vague predictions but were based on concrete data and a clear understanding of the demographic and economic pressures facing the island. He projected that if the government continued its path of inaction, SZV would be unable to pay its bills within six to seven years. Today, we are perilously closer to that deadline, with little to no meaningful intervention from those in power. The stark reality is that all governments in office from 2015 are responsible for the predicament SZV now faces.
This article exposes the gross negligence that has characterized the government's response to a predictable and preventable disaster. It highlights the specific warnings that were issued and the systemic failures that have allowed this ticking time bomb to continue its countdown.
A Deficit Fueled by Inaction and an Aging Population
The financial hole at SZV is deepening and becoming more substantial. In 2022, the combined income for key health funds, like ZOV, AVBZ, and FZOG, stood at roughly $112 million, while expenses increased to $147 million. This created an annual shortfall of $35 million—a staggering figure for a small island nation. It’s a simple, brutal equation: SZV had $10 coming in for every $15 going out.
Compounding this issue is a demographic shift that was entirely foreseeable. The average age of patients covered by SZV increased from 38 in 2014 to 45 in 2022. As the population ages, healthcare needs become more complex and costly. The cost to insure a person over 60 is nearly four times that of someone under 60—approximately 4,400 guilders per year compared to 1,200 guilders. This is not a surprise; it is a demographic reality that any responsible government should have planned for.
Instead of proactively addressing this, the government has allowed the problem to fester. The aging population continues to place unsustainable pressure on SZV's funds, and with each passing year, the financial figures worsen. This isn't a future problem; it's a present crisis. Mr. Carty was explicit, stating that if the status quo continued, the system would be insolvent. The status quo has continued.
Low Compliance and a Staggering Government Debt
While demographic shifts are a major factor, the crisis is severely aggravated by two other critical failures: widespread non-compliance from businesses and the government's own failure to pay its debts.
Many businesses across St. Maarten are simply not paying their fair share. They fail to register their employees or neglect their premium payments, starving the system of essential income. This lack of compliance is not just an administrative issue; it is a direct drain on the funds meant to provide healthcare for the sick, pensions for the elderly, and support for the vulnerable. While SZV has been left to manage the fallout, the government has failed to implement robust enforcement mechanisms to ensure everyone contributes.
More shockingly, the government itself is one of the largest debtors. As of Mr. Carty's warnings, the government of St. Maarten owed SZV an outstanding bill of approximately $100 million. It is an act of breathtaking hypocrisy for the government to expect compliance from its citizens and businesses while it simultaneously fails to honor its own massive financial obligations to the very same system. This isn't just poor accounting; it is a fundamental betrayal of public trust.
A Tale of Two Systems: The Contrast with Curacao
The government's negligence becomes even more apparent when looking at our neighbors. In Curacao, the law mandates that the government must supplement the social and health insurance body if it faces a shortfall. This legislative safety net ensures that the system remains solvent and can continue to serve the people, even during difficult economic times.
In St. Maarten, no such protection exists. "Here, in my tenure, I have never seen nothing," Mr. Carty stated bluntly, referring to the lack of financial supplementation from the government. Even during the unprecedented economic shock of the COVID-19 pandemic, SZV received no support from either the local government or the Hague. It was left to fend for itself while managing increased demands and decreased revenues.
This stark contrast highlights a deliberate policy choice by the government of St. Maarten: to let SZV operate without a lifeline. This decision has left the health and social welfare of its people dangerously exposed to financial collapse.
The Consequences Are Here
The future Mr. Carty warned about is no longer a distant threat. He stated that SZV was already running months behind on payments to healthcare providers. When doctors, pharmacies, and specialists are not paid on time, the entire healthcare delivery chain is threatened. It can lead to a reduction in services, a reluctance from providers to accept SZV patients, and ultimately, a decline in the quality of care for everyone.
The total deficit has been estimated at a staggering 400 million guilders. This is not just a number on a balance sheet. It represents a promise that cannot be kept—the promise of healthcare for our parents, pensions for our grandparents, and a safety net for our workers.
The solution, as Mr. Carty pointed out, is not a mystery. It requires a two-pronged approach: "We have to increase the income and drop the waste." Increasing income means enforcing compliance and ensuring the government pays its bills. Dropping waste requires all stakeholders—government, providers, and the public—to come together and reform the system to make it sustainable.
The time for studies, committees, and empty promises is over. The warnings were clear, the data was undeniable, and the timeline for action was short. The government of St. Maarten was told, in no uncertain terms, that inaction would lead to disaster. By choosing to do nothing, they have steered the ship directly toward the iceberg. The question now is not if the system will fail, but how catastrophic the fallout will be when it does.
Eighteen Days, No More Magic
With only 18 days left in his tenure, Director Glen Carty’s time at the helm of SZV is all but over—and it must be made clear that he cannot work miracles in such a short span. What he has done, however, is his duty: he sounded the alarm, laid bare the numbers, and warned the people and their leaders of the disaster in plain, unequivocal terms. The collapse of SZV is not on his conscience, but on those who refused to listen and act.
Now, all eyes must turn to the current Minister of VSA. With Director Carty’s imminent departure, the question is both urgent and critical: who will be appointed to steer this sinking ship? Will the next leader be a competent, experienced St. Maartener ready to tackle the dire situation head-on, or will the government continue its pattern of rewarding political cronies at the expense of the nation’s health and future? The upcoming decision will speak volumes about whether the government is finally prepared to act responsibly or whether it will once again put politics above the well-being of its people.
Source of information BDO Inaugural Conference ( Rethink St. Maarten)