About HOH according to HOH

This was a super-interesting press release published by Marilu Koolman, and Charlaine Huntington, of HOH following last week’s College of Aruba Financial Supervision, CAft, and AZV, General Health Insurance, visit at Dr. Horacio E. Oduber Hospital.

I found the release VERY interesting, yet it made very few waves, in public discussion.

So here it goes, the edited version, in English, please read.

ALSO note that THIS IS A SERIOUS MATTER. Yet, no one talks about the real issue, which is not financial. The real issue is the overall state of health of locals, on island. We incur a lot of expenses caused by preventable illnesses. Nobody talked about HEALTH PROMOTIONS and how to reduce the care demanded from the health system, by reducing the need for treatment. The BIG SAVINGS are in prevention.

Please bear in mind that CAft has an advisory role, on the road to achieving a sustainable balance in the national budget. They also occupy a central role with regard to reforms, conditioned by the Dutch as a prerequisite to financial support.

The hospital wanted to educated CAft on it many challenges, and explain its critical financial situation.


The release blames years of insufficient funding for care provided, on one hand, and too much care provided on the other because no maximum production has been agreed on, and the hospital did not provide adequate guidance, to stop OR start care according to budget availability. In other words, zero fiscal management.

ALSO, HOH suffered some high-cost shocks to its system:

The Hack in 2019. Many programs had to be bought and re-built, many protocols and documents had disappeared and all had to be re-created, to the tune of AWG 2million.

The HOH construction project required more equipment and more materials, in order to deliver an operational facility. Since the first phase of the building delivery, it was handed over damage, caused by the contractor’s poor finishing and late delivery dates. SHODDY CONSTRUCTION, created great expenses, and required extra-budgetary funds. Not all funds for damages are covered by insurance.

The hospital’s energy and water bill is now twice as high as a few years ago, mainly due to the expansion of the hospital, but also because the government has saved on sustainable heat control solutions during construction. Penny wise and dollar stupid.

The fire in 2020, which halted all care and destroyed much materials, necessitated throwing much equipment away. Some care aspects were then moved to ImSan, which caused the hospital a loss of income. The total cost of the fire was AWG 2.6million.

The Covid-19 crisis has shaken up care in the hospital. Much of the needed care has come to a standstill and/or postponed, in favor of helping Covid-19 patients. As a result, postponed care is currently valued at AWG 4.6million. The COVID costs for 2020 were covered by the government.

To make the hospital financially healthy, an initial financial investment of Awg 33million is needed. In addition, a structural increase is required, Awg 15million on top of the current budget of Awg 192million.

The latter amount is currently being cut by 5.5% due to the COVID crisis and as part of the reform agreement.

Finally, the 5.5% discount, translated to Awg 10.6million, reduction on the budget, cannot be accommodated without severely affecting the quality and quantity of care. Everything will have to be adjusted, including the workforce, the secondary employment conditions, and the special reimbursements of doctors.

HOH goes on to list the long waiting times for some outpatient clinic appointments due to COVID19 and staff shortages, because there are insufficient funds to hire extra people:

Urology: 6 months

Rheumatology: 7 months

Gastroenterology: 9 months

Pulmonary medicine: 10 months

Then there is the issue of regional cooperation, based on a decision document, in which the hospital in Curacao will undertake certain medical specialties, and treat Aruban patients, there.

The establishment of the DCHA, Dutch Caribbean Healthcare Alliance, is difficult, according to the press release. The hospital would like to play an important role in the region, but with its own autonomy and on a level playing-field with other regional facilities. This requires trust among players. More work will be done in this area, in the coming months. It is important for the hospitals to collaborate fair and square.

The issue of undocumented patients, received attention from the press release. The hospital now has more than Awg 10million in unpaid bills, from undocumented patients, who were treated. This puts enormous pressure on the hospital’s budget. For some time now, the hospital has been asking the Ministry of Justice to bear these costs and reimburse the hospital. In vain so far, which means that the Aruban population actually pays for it and receives less care itself.

HOH launched a “sustainable hospital” project in 2020 to make the hospital more efficient and effective.

It has been explained in detail to all stakeholders. In 2020, the project achieved a saving of Awg 11million – partly due to a 5.5% discount on staff salaries. In the coming years, the hospital wants to have a structurally smaller overhead and, in addition to better care, also provide more cost-conscious and more efficient service. To this end, the price tag of care requires a review. It has not been re-evaluated since 2013.

The new price tag is now being negotiated. However, the AZV is financially under pressure. The government will therefore have to take on a coordinating role and make choices in how much money is available for healthcare. If the amount remains the same, it will have an impact on service, then the government should explain to the population why it is getting less. At the same time, the hospital, and the medical staff must improve its record-keeping method, in order to bill correctly.

Only in this way can the hospital prove that it does not receive enough money for all it does. In addition, the manpower planning of the doctors will have to be re-examined and there will be more focus on patient-related time and production.

The construction disputes between OHL-SOGA-LAND Aruba-Hospital is approaching a very critical phase these days because the process has come to a standstill after it has already been delayed too much and therefore threatens to become financially unsustainable if all parties do not pursue the same interest, more effectively.

The decision-makers have been asked to get out of the impasse and to force parties to guarantee the quality and continuity, of construction. The hospital will have to be more flexible in carrying out internal relocations in order to make the renovations possible. This is critical in view of past experiences.

Just a week ago there was a major hot water leak that thankfully it didn’t harm any patients, but it was in a ward soon to be used to capacity by patients.

Patient safety remains a top priority for the hospital and it is also required by other stakeholders. With regard to the loss of beds (33) due to ongoing renovation, the hospital is on the eve of purchasing modular units that will be used first for those beds, and later for a new dialysis clinic. HOH has been waiting for a long time for the stakeholders to understand and approve the investment. The short-stay at ImSan are not a solution because ImSan can only treat low-complexity patients and cannot care for them 24/7.

Questions regarding the collaboration with ImSan, as part of the country’s reform, were answered by the hospital the following: A collaboration agreement is in the final stages and, as far as the hospital is concerned, the hospital is working towards a merger of the two facilities within 1.5 to 2 years. A merger will secure better alignment and balance in personnel, facilities and care, as well as a significant reduction in overhead costs.

When asked about the independent doctors who have to be employed by the hospital as part of the country’s reform, the hospital indicated that a hybrid model, introducing a Medical Specialist Company, is preferred. This might also serve as an interim solution in which the doctors will remain partly independent, but will also be regulated on quality, service, patient satisfaction, complications, production and the likes.

In this model, some doctors will earn more and others less. If this opportunity is not realized, all doctors will eventually have to be employed. However, the hospital will not be able to hire all because there is insufficient work for them all. If that happens, clear production and quality agreements will also have to be made. All over the world, it appears that when independent doctors go into paid employment, it means that more doctors are needed for more work and the service is not necessarily improved.

When asked about reducing the number of labs on the island as part of the country’s reform, the hospital stated that the hospital provides the most complex care at a low cost because no shareholder profit factor needs to be applied. The hospital therefore argues in favor of keeping the main lab and allowing other labs to join the hospital. To make this even more transparent, the Dutch NZA rates are currently being introduced. This makes the funding of services provided more transparent and fair.      This also results that the private labs make the most of the primary laboratory work, and that the hospital often confronts the less lucrative care, as a secondary option.

When asked about reforms in healthcare, the hospital indicated that the submitted healthcare document is the start of a multi-year project in which cooperation, coordination and prevention are central. In the coming years, more focus will have to be placed on care for the elderly in order to tackle challenges and do justice to the care elderly need.

In addition, all care will have to be strengthened in accessibility and quality in order to relieve the emergency room and GP post in the hospital. The hospital also invests in training. Educating more Aruban.

For further information or questions, please contact Marilu Koolman, email: [email protected] and by phone at (+297) 597 4380 or Charlaine Huntington, email: [email protected] and by phone at (+297 ) 597 4402

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July 13, 2021
Rona Coster