New SMMC tariffs alone won?t cause SZV premiums to go up

~ All factors to be looked at~

PHILIPSBURG--The tariffs set for new services at St. Maarten Medical Center (SMMC) alone won't cause Social and Health Insurance SZV (former Social Insurance Bank) premiums to go up.

SZV Chief Operations Officer (COO) Reginald Willemsberg said, however, that there are several factors that have an impact on SZV. These factors, he said, will be discussed in an upcoming meeting with the Health Ministry and Health Minister Cornelius de Weever to determine how to mitigate their effects on SZV.

De Weever had announced last week that he had signed the ministerial decree setting new tariffs for the hospital on November 18. The new tariffs only cover new services being offered by SMMC such as cardiology, neurology and urology. It does not address SMMC's long time call for a change in its existing tariffs to reflect actual cost of services.

Factors

Willemsberg said SZV was already accustomed to sending patients to St. Elizabeth Hospital SEHOS in Cura�ao and the tariffs for new services at SMMC are in line with that of SEHOS. As a result SZV will not have any significant impact on SZV. "Because it's for new services alone, this alone won't be a detrimental factor if premiums have to go up or not," said Willemsberg.

He said, however, that the cost of healthcare continues to increase, while SZV's income remains the same.

He said the biggest factor affecting SZV is increases in health care cost such as hospitalisation and pharmaceuticals. "This is quite a big factor and it impacts SZV. If you look at the last few years inflation went up by 14 per cent or more while medical expenses increased by 29 per cent. So this is the biggest single factor."

Additionally, since the dismantling of the Netherlands Antilles, SZV patients sent to Cura�ao for medical treatment are no longer being billed according to SVB prices. They are being billed as private patients, which is more costly.

"Specialists who adhered to SVB tariffs in Cura�ao don't have to adhere to them anymore because SZV is now considered a foreign country. We don't fall under the same jurisprudence as SVB patients in Cura�ao and this automatically affects cost of patients as it is quite an increase."

Another factor, he said is the hundreds persons more than 60 years who have signed up for medical insurance via SZV since the voluntary medical insurance law went into effect in January 2010. "A lot of people are now signing up for it," Willemsberg said, adding that between 500 and 600 persons have so far signed up. "These are the things we need to talk to government about because government has a role to play," said the COO.

In his announcement last week de Weever said in accordance to article 7 of the transitional ordinance, the minister has the mandate to designate the SMMC as the body which replaces SEHOS. This ultimately entails that the rates established for services provided at SEHOS can also be applied to the SMMC, it was stated in a press release from the Minister's cabinet.

In July 2010, the SMMC was granted a licence by the Executive Council of the former island territory, to initiate the first phase of the expansion plans of the medical centre. In its expansion request, the medical centre indicated that the expansion would eventually lead to a reduction in the country's health care expenditures, as services and treatment that are currently unavailable would be made available locally. The expansion in services would include, among other things: cardiology, urology and neurology.

"Consequently, the expansion has led to the need in establishing tariffs for this specialty. In accordance to the ordinance of health insurance, which outlines the regulations of the Social security insurance, fees for the provision of medical care are to be established by means of national decree," de Weever said.

"That decree which was transferred to country St. Maarten, stipulates the fees for specialised hospital care, however, the fees were specified per hospital, in other words, fees applicable to medical care provided in e.g. SEHOS of Cura�ao were not always in line with those of SMMC.

Additionally, the fees/tariffs were only established for care that was provided in the various hospitals. Consequently, it was not possible to automatically assume that those tariffs would be applicable to SMMC after 10/10/10.

Source: http://www.thedailyherald.com/islands/1-islands-news/23530-new-smmc-tariffs-alone-wont-cause-szv-premiums-to-go-up-.html

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