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Statia and Saba present clear-cut ideas to save health care cost


THE HAGUE–Cease referrals of patients to Guadeloupe, send more patients to Bonaire and other hospitals in the region, fly medical specialists over to St. Eustatius and Saba, and expand the cooperation between the Amsterdam hospitals and St. Maarten Medical Center (SMMC).

These are some of the concrete proposals representatives of St. Eustatius and Saba have put forward in talks with the Dutch Ministry of Public Health, Wellbeing and Sports VWS. The meeting, which is taking place in St. Maarten, started on Thursday and will continue today, Friday, with the various health care institutions.

The Executive Councils of St. Eustatius and Saba have outlined their wishes and suggestions, which should lead to substantial savings in health care cost, in a lengthy joint letter that was sent to Dutch Minister of VWS Edith Schippers on Thursday. At least US $1 million per year could be saved by organising health care and referrals more cost-effectively.

Schippers wants to reorganise the health insurance package and exclude a number of treatments such as dental hygiene and physical therapy per July 1, 2013, in an effort to reduce the increased health care cost in the Caribbean Netherlands.

It was agreed during the last Caribbean Netherlands week in The Hague that the Minister would reconsider her original plans if an alternative plan could be realised. This plan had to reduce health care cost by $2 million without actually harming the quality and extent of health care on the islands. The governments of St. Eustatius and Saba went to work right away and started talks with health care providers.

One of the most direct suggestions in the letter of the two island governments that The Daily Herald has obtained is to terminate the contract to refer patients to Guadeloupe in 2013 or at least to stop reserving structural cost for apartments and personnel.

According to St. Eustatius and Saba, the cooperation with Guadeloupe to treat patients from the islands has not led to the “desired results and is now a structural burden,” considering the limited use and the relatively high patient cost.

Patients are positive about the quality of care offered in Colombia, but the long and unnecessary waiting times at the hospitals there lead to needless travel and lodging cost. Colombia doctors also tend to perform additional tests that are unrelated to the original reason for referral, which St. Eustatius and Saba called a “total makeover attitude.”

Flying in medical specialists to St. Eustatius and Saba is much more cost-effective and less time-consuming for the patients. A visiting medical specialist will cost about $1,500 per day, whereas the cost of sending 10 patients to hospitals in the region is between $3,500 and 5,000. The visiting medical specialists could be flown in from Bonaire’s Mariadal Hospital, which has a cooperation agreement with the VUmc and AMC hospitals in Amsterdam.

More patients could be sent to Bonaire, as this would cut down the number of referrals to Colombia. There is sufficient operation capacity at Mariadal Hospital. “The safety and quality of care is also safeguarded there and the money would be spent within The Netherlands,” stated the Statia and Saba Executive Councils in their letter. A proper connection by air between the Windward Islands and Bonaire is imperative.

St. Maarten and St. Martin are also an option to reduce cost. “We remain of the opinion that basic and acute care can best be delivered by SMMC. For this reason, we consider it desirable to resume the cooperation between the Bonaire hospital and SMMC and to extend the twinning between Amsterdam and SMMC.”

The Executive Councils further pointed out that a medical test, scan or ultrasound is less expensive in French St. Martin than in Guadeloupe. Referrals to Puerto Rico also should be considered seriously.

Making use of so-called E-health, communicating via video conferencing or the Internet, could further save travelling cost, as it offers prospects to communicate with doctors at the hospitals in Bonaire, St. Maarten, Colombia and The Netherlands about diagnostic results.

Savings are also possible at the Health Insurance Bureau ZKV where, according to St. Eustatius and Saba, “unnecessary management and administrative cost” is incurred because of bureaucracy, excessive personnel and too many intermediates, and bad planning resulting in unnecessary travel and lodging expenses.

Representing St. Eustatius at the mini-conference in St. Maarten on Thursday and Friday with the Ministry of VWS and health care institutions are Commissioner Koos Sneek and Island Secretary Jan Helmond.

Saba’s Commissioner Bruce Zagers is accompanied by Saba Health Care Director Dr. Joke Blauboer and Saba Health Care Foundation Chairman Sydney Sorton. Commissioner Zagers said in a press release on Thursday that it was “imperative” to find a solution to reduce cost while maintaining the quality of health care on the islands.

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