Curaçao and St Maarten blamed for foiling cooperation in Healthcare

The Daily Herald writes that closer cooperation in healthcare in the Dutch Caribbean is possible and desirable, but is frustrated by developments on especially Curaçao and St. Maarten. The latter country is accused of obstructing the medical evacuations from St. Eustatius and Saba.
Dutch Minister of Public Health, Welfare and Science Edith Schippers sent a letter to the Dutch Parliament on Thursday, in which she confirmed her attendance to the Kingdom Health Congress which will be held in Aruba from June 1-4. The letter was accompanied by a five-page paper on healthcare containing advice, an analysis and strategy for the Aruba congress as well as the Kingdom Congress, which will take place on Curaçao probably on June 16, where healthcare will be on the agenda as well. The paper is part of the preparation of the Dutch delegation for the two congresses.

The need for closer cooperation among the Dutch Caribbean countries was stressed in this paper. Different interests and care systems have prevented the countries from arriving at agreements on healthcare. According to the paper, St. Maarten has been complicating evacuations of acute patients from St. Eustatius and Saba because “St. Maarten wants to earn more,” former Prime Minister Sarah Wescot-Williams was quoted as having said. “St. Maarten wants the Caribbean Netherlands health insurance to purchase the helicopter services on St. Maarten, despite the costs which are more than twice as high. They have even resorted to creating regulations that forbid foreign operators from deploying services,” it was stated in the paper.

The paper also stated that St. Maarten has “insufficiently invested in its only hospital.” The St. Maarten Medical Centre (SMMC) has half of the budget that it actually needs for a basic medical facility, it was stated in the paper that was sent to Minister Schippers and her colleague Minister of Home Affairs and Kingdom Relations Ronald Plasterk early February this year. “The tariffs have remained unchanged for 10 years and they are too low. Government doesn’t want to adapt this. The hospital can insufficiently exploit basic specialties. The capacity and quality is below par. This makes the many medical referrals to Colombia and Guadeloupe necessary.”

On Curaçao, cooperation is thwarted and the hold on the cost and quality on healthcare lost by the local care system, which allows medical specialists to operate their own clinics outside the hospital. This results in a waste of money in healthcare with people having to pay a lot for expensive, unnecessary treatments and mostly inferior care; it was stated in the paper.
The current care system on Curaçao has foiled cooperation between Curaçao and Bonaire. The Curaçao Government has not been able to change this system so far. Cardio invasive treatments (catlab) are being set up on both Aruba and Curaçao, which are only profitable with an adherence of more than 300,000 residents. “So far parties have refused to arrive at an agreement on this.”

According to the paper, the Dutch Caribbean countries are too small to each carry their own sufficiently covering, high quality care system, which is why cooperation is essential. Differentiating of healthcare offered on Aruba, Curaçao and St. Maarten presents a solution. For example, by developing oncology on Curaçao, which makes it possible to purchase expensive radiation equipment and making it also more interesting for oncologists to establish on this island. This gives the other countries space to focus on, for example, cardiologic surgery, orthopaedics and neurologic surgery.

The people on the three islands, but also residents of Bonaire, St. Eustatius and Saba, would benefit from this approach. The cost of healthcare would go down, medical referrals to Colombia and Guadeloupe could decrease and the overall healthcare system would improve and become more sustainable. The healthcare issue was a highly current topic, it was stated in the paper, because Aruba, Curaçao and St. Maarten were simultaneously making irreversible steps where it came to their (new) hospitals.
Minister Plasterk has promised to discuss the topic with the overseas countries at the Kingdom Conference on

Curaçao in June. Minister Schippers has offered to help the countries with know-how and expertise; however, it is up to the countries to define their specific request for assistance and to make clear choices where it comes to differentiation of their healthcare specialties.

In her letter to the Dutch Parliament, Schippers stated that she supported the concept of closer cooperation in healthcare. The success of this cooperation largely depends on the willingness of the governments and local healthcare authorities to make choices. “It is in the interest of the people that this happens,” the minister stated.

Schippers confirmed that she would be attending the Kingdom Health Congress on Aruba early June. Together with Minister Plasterk, she will work on realising more cooperation in healthcare in the Dutch Caribbean. Schippers said she hoped that the congress would yield fruitful results.

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