Opinion | Healthcare in TCI: A Blessing We Can No Longer Take for Granted

For the better part of almost two decades, the people of the Turks and Caicos Islands have enjoyed something that many residents of other countries can only dream about: relatively affordable access to a healthcare system that can provide everything from routine medical care to major surgery and, when necessary, treatment overseas.

But there is a question we can no longer avoid: Can we afford to continue providing healthcare the way we have been providing it?

I have lived abroad and experienced firsthand what healthcare can cost. Believe me, the Turks and Caicos Islands have a lot to be thankful for.

For NHIP beneficiaries, a $10 copayment can provide access to a doctor, while many hospital services and surgical procedures carry little or no patient copayment. An emergency-room visit can be just $10 when covered under NHIP, while out-of-hours urgent care for a non-emergency carries a $50 copayment.

Think about that for a moment.

We have people complaining about a $10 medical visit while, in other countries, simply walking through the doors of an emergency department can result in a bill of hundreds or even thousands of dollars.

And when something cannot be treated here, NHIP can send patients abroad.

That can mean treatment in the Caribbean, the United States or increasingly Colombia. NHIP also covers medically necessary air ambulance transportation for approved cases.

A private air ambulance can cost tens of thousands of dollars.

So yes, we have it good. But good does not necessarily mean sustainable.

The InterHealth Canada public-private partnership has provided the TCI with modern hospital facilities, equipment and secondary-care services since the hospitals opened in 2010. Yet today, that relationship is under serious strain. Government says InterHealth’s clinical costs have been paid and that disputed amounts relate to contractual performance issues. InterHealth has disputed the Government’s position.

Whatever the legal and contractual outcome, the public deserves more than statements after the fact.

And I think its important to highlight one thing: Although the Honourable Knowles currently sits in the driver’s seat on this matter, this issue did not begin with him. It preceded his tenure and has been in the making for quite some time. Whatever decisions are made now will ultimately have to address problems that have been developing for years.

So where is the contingency plan?

How long has Government been preparing for the possibility that InterHealth would no longer operate the hospitals?

Why wasn’t the public given greater transparency when negotiations began to deteriorate?

What will the new arrangement cost? And perhaps the biggest question of all: Are we getting value for the money we are spending?

Government has historically budgeted more than $30 million annually for InterHealth clinical services. That is only one component of the healthcare bill. Treatment abroad, medications, primary care, staffing, utilities and other healthcare costs add considerably more.

At some point, we have to stop pretending that healthcare is free. It isn’t. Someone pays.

And if the number of people using the system continues to grow faster than the number contributing to it, the mathematics eventually become impossible to ignore.

That doesn’t mean abandoning universal access. It means having an honest conversation about what we can afford.

Perhaps some copayments need to increase. Perhaps there should be greater cost-sharing for certain services. Perhaps we need to invest more aggressively in preventative medicine and local specialists so that fewer patients need to be sent abroad.

The expansion of polyclinics could be a major part of that solution to include eye care services. If people can receive appropriate treatment closer to home, emergency departments can concentrate on genuine emergencies rather than becoming the default entry point into the healthcare system.

But there is another uncomfortable reality.

As our population ages, healthcare demand will increase. An aging population requires more chronic-care management, more diagnostics, more medication and more specialist services.

We cannot simply keep adding costs and assume tomorrow’s taxpayers will somehow figure it out.

The InterHealth situation should therefore be viewed as more than a contract dispute.

It is an opportunity to ask whether the entire model needs to evolve.

I don’t want to see the people of the Turks and Caicos lose the healthcare benefits they have come to depend on.

But I also don’t want us to wake up one morning and discover that the system we assumed would always be there is financially broken.

Healthcare in the TCI has been both a blessing and, potentially, a dilemma. The blessing is what we have built over the years. The dilemma is whether we can afford to maintain it. The time to have that conversation is before the crisis and not after it.