Do things differently

As published last week across several media outlets, Aruba’s caregivers asked CAft what was the basis for the draconic request to cut much-needed millions from the island’s health care budget.

Break it down, show us, they basically said, we are eager to learn.

How is it possible that we do better than the Netherlands in health care expense, better than Curacao, and the other islands, but still you want us to reduce 60M a year. Explain please.

And…while you are at it, reverse the demand.

You also know, dear reader, that as soon as the demand was made, apparently based on some PWC report from November last year, MinTVS said OK like a little kid, never protesting it was too much money.

The Dutch must have thought “Hummm….interesting, they just swallowed and said nothing, instead of immediately fighting back.”

I spoke to a girlfriend pharmacist about an upcoming storm brewing, part of this same outrage, the crack down on medications. It is an impossible scenario she says, the pharmacists will be asked to play god, helping their patients decide what to get, the medication relieving their heart condition or the one helping their blood pressure, both equally important but out of patients’ reach, thanks to the new policy.

Many people will get very sick, fast, she says.

Entire groups of medications, she continues to explain, were wiped off the menu which means pharmacies will not stock them, so even if you are willing to pay for Histal, for example, they will not have it available because why should they make the investment, air condition the drug and let it expire on their shelves, just in hope you buy it.

Not many pharmacies will survive she predicts, because the volume of business will spiral down.

AZV she reports was set up in a rush as a political tool, pre-elections, in 2000, that’s 20 years ago. It should have been set up more carefully, for example if an ex-pat is working with a permit here and brings in his family members, they are now all insured by AZV. One salary contributes to the fund and five people, sometimes more, hang on AZV’s neck for 100% of their health care costs.

These expenses, she says, should be carried by the company who hired the expat via a private insurance. With a similar scenario applicable to ex-pat second home owners, they should get adequate coverage via a private plan, and not burden the national system.

But because coverage was designed so broadly, the country is burdened by a large number of insured and a small number of contributors.

The changes she says, should be made at the source, with eligibility re-defined.  The way it is designed now, there is no fat that could be trimmed off.

The system should be redesigned.

From the PWC reports: In recent years, healthcare costs have risen from Awg 357.3M in 2014 to Awg 425.7M in 2018. The trend of rising healthcare costs is visible worldwide and is partly caused by aging and increasingly expensive medications, in addition, advanced expensive technology is increasingly being used and applied.

If the healthcare costs in Aruba continue to develop in the same way in the coming years as in the period 2014 to 2018, the national contribution will increase significantly. Meaning GOA will have to kick money on, because our healthcare financial situation is not sustainable in the future. Action will need to be taken to bridge the gap between income and expense.

Then the reports states that changes are possible and points among others, at the organization of care, remote care and coordination of care for FREQUENT USERS that will lead to control of the growth in healthcare costs.

We have a group of frequent users. This group represents 4.9% of our population, yet they cost Awg 189.5M in individual care.

That’s a shocking number.

Of course some of them are very sick people, but many of them would benefit from just diet and exercise.

We are a fat island, and consequently a wasteful island, and as long as our consumption isn’t addressed and curtailed – all consumption, from food to drink to money – we will continue our slide downhill.

The report mentions PREVENTIVE INTERVENTION, as an aside. But this is the core issue, our health care system must transform from sickness insurance to health assurance, and aggressively intervene with sport and nutrition promotion.  Do things differently.  


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December 07, 2020
Rona Coster