Overseas care costs millions

Each year, hundreds of people at a cost of millions of dollars leave Cayman to get medical attention overseas.

Between July 2010 and June 2011, the Overseas Referral Office at the Health Services Authority, which handles the vast majority of cases referred off island for medical care, processed 1,557 cases.

During the financial year 2008/2009, 729 CINICO patients were referred overseas. A year later, that number had climbed to 784.

According to the latest statistics from the government insurance company CINICO, total overseas claims from its members came to $15.1 million for the last financial year, an increase of almost $2 million on the previous year.

One third of all its claims for the financial year 2009/2010 were for overseas medical care.

Medical director of the Health Services Authority Dr. Greg Hoeksema said the authority is carrying out a major project to see how specialist care can be improved locally with a view to treating more cases on island.

“We’re looking at what kinds of cases have the most frequency and the highest cost and, most importantly, what are the most difficult ones for people to have care overseas; by that, I mean, it is one thing to have to fly off the

Island to have special surgery done to your wrist, it is another thing to have to go overseas and have cardiovascular care and have to stay several weeks and be in an intensive care unit,” he said.

The impact on the patients’ families is also being looked at in the project.

The cost of overseas care does not just involve the medical fees, but also what is spent on transporting the patients overseas, transport when the patients reaches the destination, hotel bills and other peripheral costs to the patients and to their family members who may travel with them. Some insurance companies will cover part of those costs, depending on the insurance premium.

Heart care

The largest block of patients covered by CINICO who travel off island for medical care are cardiovascular cases – in 2009/10, 177 went abroad for treatment, at a cost to CINICO of $3.5 million, compared to 127 patients the previous year at a cost of $2.2 million.

Last year, Dr. Devi Shetty, who is proposing to build a medical tourism hospital in Cayman, announced he would donate a catheterisation laboratory, known also as a cath lab, to the Cayman Islands Hospital. Although an operating theatre has been revamped to accommodate the cath lab equipment, as part of an overall upgrade of the hospital’s operating theatres, it has not arrived on Island. A lack of cath lab, in which heart surgeries can be done, and a full-time cardiologist in Cayman means heart patients who require operations must be sent overseas.

“We are working hard to try to build a cath lab and to have a full-time cardiologist at the Cayman Islands Hospital,” said Hoeksema. “We are still pursuing that project aggressively. We don’t have a timeline just now to say when that is going to be implemented.”

But that does not mean there is no cardiovascular care at the hospital. Some cardiology services are available locally through a public/private partnership, Hoeksema pointed out, but if heart patients require intervention, they still need to go off island.

Cancer cases

According to CINICO, the most expensive block of cases were cancer cases – 89 patients travelled off island for care at a cost of $3.7 million.

There is no full-time cancer specialist on island. Two visiting oncologists, Dr. Theodore Turnquest at Chrissie Tomlinson Memorial Hospital and Dr. Gilian Wharfe at the Cayman Islands Hospital, come to Cayman regularly.

The Cayman Islands Hospital has also been hoping to employ a full-time oncologist. “On a couple of occasions, we have been very close to believing we had someone who would be imminently coming on board. Unfortunately, at the last minute, it didn’t work out,” said Hoeksema, adding that he felt “personal angst when I think about the fact that cancer patients have to go off island to get their care.”

He said the hospital was still trying actively to find a full-time oncologist to come to Cayman to practise.

In the meantime, as well as having a visiting oncologist, the hospital has also expanded its chemotherapy services, so the number of patients who previously had to go overseas to undergo long chemotherapy treatments has dropped.

In the 2009/2010 fiscal year, 122 CINICO patients with musculoskeletal disorders were treated overseas, at a cost of $1.6 million, while 95 neurologic cases at a cost of $1.9 million were treated abroad, and seven hematology/infectious disease cases were referred overseas at a cost $1.2 million.

For years, cases of carcinoma/oncology, cardiovascular, neurologic and musculoskeletal have been the top five diagnoses for overseas treatment due to Cayman’s limited capacity of technology, specialists, and infrastructure required to service these types of cases, the CINICO annual report stated.

This financial year may see a drop in the number of neurologic cases referred overseas as Cayman now has access to three neurosurgeons. Dr. James Akinwunmi and Dr. Peter Kowlesser visit Cayman monthly and work out of Chrissie Tomlinson Memorial Hospital and Dr. Lowell Stanley joined the Cayman Islands Hospital in May as a full-time neurosurgeon.

This means that cases, which in the past involved patients needing to be taken off island for treatment to severe back or brain injuries, can now be operated on locally.


Claims for another procedure is also climbing among CINICO members – bariatric surgeries for weight loss are increasing.

The first six such CINICO-covered cases were referred overseas in 2008/2009. The following year, CINICO covered 23 overseas bariatric cases.

“There are a few common surgical procedures that provide immediate results and as a result, as members become better educated, it is forecasted the number of bariatric referrals for subsequent years would increase immensely.

However, this is not necessarily a bad thing, as addressing obesity would lead to decreases in cases relating to cardiovascular, diabetes, kidney failure, etc,” the insurance company’s annual report stated.

During the year 2009/10, the Baptist Hospital of Miami continued to account for the highest share of CINICO’s overseas claims at 28 per cent. The referrals to Baptist vary by diagnosis, but a majority related to carcinoma/oncology, cardiovascular, and gastrointestinal treatments and care.

Hoeksema said the dream was to one day to have enough specialists and equipment on island to enable no-one living here to have to go overseas for medical care.

Medical tourism

The creation of a medical tourism hospital in Cayman may eventually mean that fewer and fewer patients need to seek treatment off island.

Last month, the developers behind the proposed hospital announced it would be built in East End, at a site that had been touted as a potential sea port development.

The Narayana Cayman University Medical Centre, which has been described as a health-care city, will cost about $2 billion and feature a hospital, medical university and assisted-living facility and target American patients and insurance providers seeking deep cost reductions. It would offer cardiology, orthopaedic, cancer and major surgical procedures.

According to details of the deal released last year, Caymanians referred from the Health Services Authority will get a 20 per cent discount on surgeries at the hospital.


One area that has seen a significant drop in the number of cases that require overseas care is premature births. Previously, that was among some of the most expensive individual cases seen by CINICO as treating premature babies can be in excess of $1 million.

However, in 2009, the Cayman Islands Health Services Authority expanded its technical staffing and introduced new equipment to its neonatal intensive care unit, so non-complicated premature baby cases of 26 weeks or later no longer need to be sent overseas.

Premature baby cases costing more than US$200,000 dropped from 10 cases in 2008/09 to just one case in 2009/10.

But, despite improvements in some areas of specialist care in Cayman, according to CINICO, the number of large cases (greater than US$200,000) in 2009/10 increased by 44 per cent.

“The dollar amount attributed to these cases has dramatically increased by 43 per cent, from $3.9 million in 2008/9 to $5.5 million in 2009/10. Out of the 13 large cases in 2009/10, two related to carcinoma/oncology total

ling US$2 million, and two related to the diagnosis of hematology/infectious disease totalling $1.2 million.

“The remaining $2.3 million related to diagnoses of cardiovascular, gastrointestinal, musculoskeletal, neurologic and bariatric,” the CINICO report stated.

During the year 2009/10, the Baptist Hospital of Miami continued to account for the highest dollar share of CINICO’s overseas claims at 28 per cent. The referrals to Baptist varied by diagnosis, but a majority related to carcinoma/oncology, cardiovascular, and gastrointestinal.

Baptist Hospital of Miami also received the majority of overall referrals of CINICO cases (32 per cent for 2009/10 versus 27 per cent for 2008/9) for carcinoma/oncology and cardiovascular. Jackson Memorial Hospital accounted for a 17 per cent share of the overseas referrals by claims dollar. Most of the referrals to Jackson Memorial were catastrophic in nature, mostly neonatal and neurologic cases, and thus a high dollar amount, even though only 6 per cent of overall referrals went to that hospital. Miami Children’s Hospital accounted for 9 per cent of the CINICO’s overseas referrals claims dollar which included one large carcinoma/oncology case.