Opinion | Sixteen Years Later, TCI still doesn’t have the Hospital/ Healthcare We Paid For — But We Can Build the One We Deserve
- 'Paladin'
- 1 day ago
- 5 min read
Something is not quite right with the Turks and Caicos Islands National Hospital. Sixteen years after its grand opening, rooms built in 2010 still sit empty. Equipment purchased with public money still sits in plastic. Services we were promised have never materialized. And while the public waits for answers, we are treated to glowing anniversary articles celebrating “advances” that somehow never reach the patient experience.
The question is no longer whether something is wrong. The question is why, and more importantly, what we can do about it. To understand the “why,” we must start with a truth most people still do not know: The people of Turks and Caicos paid to build the hospital — but the people do not own it.
A Hospital built with Public Money, But Not Publicly Owned
When the hospital was constructed, the public financed it through long‑term payments. But instead of becoming a public asset, ownership was placed into private companies created solely to hold the building and collect rent from the Government.
The result is astonishing:
TCIG owns only the land.
A private company owns the building.
Another owns the equipment.
Another provides the services.
And the Government pays rent every month on a building the public already paid to build. This structure explains almost everything that frustrates the public today. But now, sixteen years later, we are seeing the consequences of this structure in the most dramatic way possible:
InterHealth Canada has terminated its contract, stating the Government failed to pay its bills for more than 18 months.
Eighteen months of unpaid obligations
A year and a half in which the operator claims it continued running the hospitals without receiving full payment. This raises a question that no one in Government has answered:
Where did the money go?
How does a government fail to pay the operator of its national hospital for 18 months while overseas treatment costs explode to nearly $64 million? This is not just a financial lapse. This is a governance failure — one that demands a full investigation.
Why Rooms Sit Empty and Equipment Sits Unused
The hospital was designed with “shelled” rooms — empty spaces meant to be opened as the population grew. Sixteen years later, many remain untouched. Why?
Because the operator is paid a fixed amount per person per year — a system called capitation. Whether they treat one patient or one hundred, they receive the same payment. So every new service line, every new specialist, every new diagnostic machine is a cost, not a benefit.
This is why:
rooms remain unopened
equipment remains wrapped
services remain limited
patients continue to be sent abroad
The hospital is not failing. The incentives are. And now, with the contract dissolved, we see the final proof: A system built on misaligned incentives collapses the moment the Government fails to meet its obligations.
But Pointing Out the Problem Is Not Enough
Turks and Caicos does not need more outrage. It needs a plan.
And the good news is this:
· Small Caribbean nations have already solved the exact problem we are facing.
· We do not need to reinvent the wheel.
· We simply need to choose a better model.
But before we choose that model, we must confront another governance issue that emerged this year; The Government spent $12 million to purchase the former Family Care facility to convert it into a polyclinic. A polyclinic is needed — desperately. But the timing and the price raise serious questions.
Why did it take twenty years for the Ministry of Health to realize it needed this facility? And more importantly, how is the valuation justified?
Healthcare facilities are valued using standard formulas: annual revenue, patient volume, equipment value, and operating profit. If Family Care was worth $12 million, then by standard valuation formulas it would have needed to generate millions per year in profit.
Is that realistic? Is that possible? Has anyone seen the financials? And if the Government is now purchasing private clinics, then the next question becomes unavoidable, what happens to all the other Government clinics scattered across the islands?
Do they fall under the same management umbrella? Do they remain fragmented? Do they integrate into a unified primary care network? No answers have been provided. Even when the Government gets it right, it is too little, too late.
Staffing, supplies, and equipment will take months before the polyclinic opens. And the same registration and payment bottlenecks that plague the hospital will simply transfer to this building unless the underlying system changes.
Here Are Three Solutions — Proven, Practical, and Entirely Within Our Reach
1. Build a Teaching Hospital Model — The Caribbean’s Most Successful Strategy
Across the region, teaching hospitals have transformed small nations with limited populations into medical hubs:
Grenada (St. George’s University)
St. Kitts (Ross University)
Barbados (American University of Barbados)
Saba (Saba University School of Medicine)
St. Maarten (AUC School of Medicine)
These institutions bring:
specialists
research funding
faculty
modern diagnostics
international partnerships
and most importantly, a pipeline of local doctors and nurses
A teaching hospital is not a cost center. It is a revenue engine. Students pay tuition. Faculty bring grants. Research brings investment. Specialists relocate permanently. And the standard of care rises for everyone. TCI can do the same — and do it better.
2. Build a 50–100 Acre Medical Village — Not a Small Building with a Big Sign
In 2008, a former Chief Minister envisioned exactly this:a Medical School, Nursing College, Dental School, and full Academic Village. He understood that a Medical School is not just classrooms — it is an ecosystem:
housing
supermarkets
restaurants
laundromats
entertainment
transportation
student services
research centers
specialized clinics
This is not fantasy. This is how every successful Caribbean medical university operates.
A 50–100-acre medical village in Turks and Caicos would:
create hundreds of jobs
generate new entrepreneurial opportunities
attract international students
anchor research partnerships
support specialist clinics
and permanently reduce the need for overseas care
It would also create something priceless: A Domestic Healthcare Workforce trained at home, loyal to home, and invested in home.
3. Use the Medical Village to Deliver Free or Near‑Free Healthcare for Citizens
This is the part most people do not realize: A properly structured Medical University subsidizes the National Healthcare system.
How? Because:
tuition revenue
research grants
specialist clinics
private care wings
international partnerships
…all generate income that can be reinvested into public healthcare.
In several Caribbean islands, citizens receive:
free primary care
free diagnostics
free specialist clinics
free emergency care
Because the teaching hospital model pays for itself. TCI can do the same — and do it sustainably.
The Choice Before Us
We can continue with the current model:
empty rooms
unused equipment
limited services
rising overseas referrals
unpaid hospital bills
unexplained Government spending
and a system that costs more every year but delivers the same
Or we can choose a new model:
a teaching hospital
a medical village
a 50–100-acre academic campus
a pipeline of local doctors and nurses
expanded services
modern diagnostics
and free or near‑free healthcare for citizens
This is not a dream. It is a decision.
Sixteen years is long enough to diagnose the problem. The next sixteen must be about the cure. Turks and Caicos deserves a hospital that grows with the nation — not one that celebrates anniversaries while standing still.
The future of healthcare in this country depends on whether we finally choose to build the hospital we were promised, the hospital we need, and the hospital our people deserve.