Minister Lee: “Quality health care is why we’re working on NHI; Govt. is committed to doing this sustainably, and realistically”

Minister of Health, Social Affairs and Labour Emil Lee


PHILIPSBURG – Minister of Public Health, Social Development and Labor addressed members of the media in Wednesday’s, July 19, Council of Ministers Press Briefing.

First, he mentioned that the Ministry of VSA is in the process of moving into the new government building. So the Departments of Public Health, Community Development, Social Development and the Labor Department “are in the process of boxing up everything that they have in their offices and moving into the new government building.”

“This is very good because we are being financially responsible, making sure that we are as government vacating premises around the capital that we are renting, so that rent will be allocated towards the payments towards the new government building,” Minister Lee said.

It will also improve efficiency, giving people “the ability to be able to just go down a couple flights of stairs and talk to different people within the Ministry. I see already that it has great benefits for the productivities and efficiency of the Ministry,” he noted.

Then, the Minister addressed an article published in the newspaper about the SHTA’s reaction to an announcement about government’s plan to work on a National Health Insurance (NHI).

“We are talking about people’s health, people’s lives. it’s obviously something that every individual feels a personal interest in. So it’s obviously a very heated and emotional discussion, and at its core we have an issue where we’re trying to merge two fundamentally different systems. Under our SZV structure, people are paying a percentage of their income as their contribution towards health care. In our private sector system, private insurance, people are paying based on risk…In a new system where their contribution is based on salary, all of a sudden that person would see a very significant change in the amount of money that they would be contributing towards National Health Insurance and therein lies the crux of the problem,” Minister Lee explained.

The Minister noted, “It is really a very fundamental and difficult discussion to have, but a discussion that I think needs to take place, and a conclusion needs to come out of it.”

Then, he went on to address several points from the article “because the topic is so broad and there are so many aspects to it.”

First, “there was a comment that the process was being prepared under great pressure and stress, that the process is too rushed. First…as I was looking for documents to prepare, I found documents from 2009 when actually I was president of SHTA. This discussion about National Health Insurance has been taking place for many years. Depending on political circumstances, those discussions have ebbed and flowed as interests and agendas have changed, but the discussion has been at least since 2009,” Minister Lee stated.

“We’ve tried to make the discussions as comprehensive as possible. We’ve included feedback from all other stakeholders, not only from the Netherlands, but also throughout the Caribbean, from different systems from the Dutch Caribbean islands, but also from other islands in the Caribbean because their model is similar to ours,” he continued.

“We’ve tried as much as possible to incorporate private sector mechanisms into what we’re looking to implement, and I think this is revolutionary because many of the other countries have not incorporated private sector mechanisms, such as some sort of an own risk, whether it’s a deductible or co-payment, the reductions of premiums based on a healthy lifestyle,” Minister Lee went on to explain.

The next point he addressed was “about government fails to live up to its financial obligations. This is a point I understand. In reality this building belongs to SZV because government, over the past, has not lived up to its financial obligations, and as part of its debt settlement, government had to transfer the building to SZV, but I full confidence in our Minister of Finance that we are working structurally,” the Minister stated.

“We are making hard decisions and we’re working structurally to improving the financial situation of the country. We certainly have had some battles within our Council of Ministers…That’s natural when there’s just not enough resources for government to do all of the projects that it needs to do, wants to do, must do,” he went on.

“The fact is I don’t think you can let that be the barrier to moving forward. That’s something that government’s working on…There’s all kinds of projects that need to take place and government is financially challenged and those are things that need to be improved, but it doesn’t mean that government can stop working on progress in the meantime,” Minister Lee said.

Another point in the article is “SHTA doesn’t agree with the interpretation of CFT’s instruction. CFT is a financial supervisory body, and their letter of instruction and their concern stemmed not from the quality of health care, but from financial concerns. So their ultimate concern is that if we do not manage health care in the costs of health care eventually those financial risks will either go to SZV, for which government is ultimately financially responsible or to government itself so. In the end they have not specified that we need to do NHI,” he explained.

“So rather than taking an ad hoc approach, I think that government is doing the right thing by taking a structural approach to how we re-engineer health care and I think it’s also important to mention that while we’re talking about NHI, which is a legislative proposal, which we hope to have in parliament, which I must have in Parliament at the end of the year for debate, it is only part of our health care reform,” the Minister observed.

Minister Lee noted “We’re been working on a national health reform and there’s many things we’re working on to improve their overall quality of healthcare, including the new hospital” and including the registering of specialists in St. Maarten, who are working with an older legislation that needs to be customized and updated for St. Maarten specifically.

“We’re working on prescription drug costs, we’re working on refining our referral process, making sure that the people that we’re sending abroad, that we’re more economically efficient and that the outcomes are better. So we’re working on all of the different parts of health care of which NHI is just one portion of it,” Minister Lee said.

One recommendation from SHTA was to postpone, “and I don’t believe that postponing the implementation of some form of National Health Insurance would be responsible. We’re working on the system overall. We have issues right now where people cannot access health care in our private sector system in private insurance,” the Minister noted.

“I understand the concern and I think it’s important that private sector and everyone recognizes that legislation is something that’s fluid. We can come with a proposal for NHI, we can monitor how it’s working, how in reality it’s performing and if adjustments need to be made,” he continued.

Next, they referred to a deficit in good governance. “The legislation has gone through its appropriate legislative track, it’s gone through Council of Ministers, its gone through SER, its gone through Council of Advice. We’ve always tried to do things as responsibly and as transparently as possible…We believe that a significant number of changes have been made to NHI,” the Minister informed.

“Originally in the first term, we had an instruction to finish that National Health Insurance by the end of 2016, but based on the discussions that we had and with the understanding that it is a complicated topic, this is not something that you can just piece together and it’s certainly not something that you can do without consultation from stakeholders. So because of that we were given till the end of 2017, to finalize our plans,” the Minister further informed.

“So we’ve made a number of changes, and these changes to the legislation are based on conversation with stakeholders. So I think when stakeholders say they’re not sure if their viewpoints have been taken into account, I think that’s grossly inaccurate because enough of their viewpoints have been incorporated that the NHI legislation has changed to the point that we believe it’s responsible to go back to the SER and Council of Advice for updated opinions,” Minister Lee stated.

“I think the dialogue is a healthy conversation and it’s something that I expect will continue. Quality health care is why we’re working on a new hospital, that’s why we’re working on reforming our overall health care system, that’s why we’re working on National Health Insurance…As government we are committed to making sure that this is done both financially sustainably, and financially realistically,” the Minister concluded.