HEALTH INSURANCE COVERAGE IN THE CAYMAN ISLANDS: WHAT THE CENSUS 2010 RESULTS REVEAL

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1 C A R I B B E A N C O M M U N I T Y S E C R E T A R I A T THIRTY- EIGHTH MEETING OF THE STANDING COMMITTEE OF CARIBBEAN STATISTICIANS SCCS/2013/38/10 Frigate Bay, St. Kitts and Nevis October October 2013 HEALTH INSURANCE COVERAGE IN THE CAYMAN ISLANDS: WHAT THE CENSUS 2010 RESULTS REVEAL

2 Health Insurance Coverage in the Cayman Islands: What the Census 2010 Results Reveal Maria Zingapan I Economics and Statistics Office I Cayman Islands 23 rd Meeting of the Standing Committee of Caribbean Statisticians 31 October 2013 I St. Kitts and Nevis

3 The Cayman Islands Health Insurance Law* The 1997 Health Insurance Law and Regulations came into force in 1998: health insurance for all employees, with employer and employees meeting the premium costs Health Insurance Regulations (2005 Revision): established the Standard Health Insurance Contract One (SHIC 1) as the minimum contract of prescribed health care benefits to be sold by approved health insurance companies. * Cayman Islands Health Insurance Commission

4 The Cayman Islands Health Insurance Law* The Health Insurance Law requires that every person resident in the Cayman Islands have, at a minimum the Standard Health Insurance Contract One (SHIC 1). Employers are responsible for providing health insurance for all of their employees, the employee s unemployed spouse and any of the employee s dependent children who reside in the Cayman Islands. The health insurance coverage must be obtained through an approved health insurance company. A self-employed person must provide their own cover with an approved health insurance company and their unemployed spouse and dependent children should also be covered.

5 The Cayman Islands Health Insurance Law* An employer shall be liable to pay the total cost of the premium of the Standard Health Insurance Contract One (S HIC1) but shall be entitled to recover directly from the salary, wage or other remuneration of each employee, 50% of the cost of the premium. The employer is not required to contribute to the premiums for the employee s dependent children or unemployed spouse and can deduct those amounts as arranged with the employee. If a person, because of limited or inadequate financial resources is unable to pay for their health care services or pay for health insurance cover, an assessment of their financial circumstances can be carried out by the Department of Children and Family Services to determine their eligibility for assistance

6 The Cayman Islands Health Insurance Law* If a person is refused health insurance coverage by two or more approved insurers, that person becomes an uninsurable person under the law. That person may then make an application for coverage with the Cayman Islands National Insurance Company (CINICO), an independent government-owned health insurance company, established to provide health insurance for those persons unable to obtain coverage either for health reasons or financial reasons.

7 Census 2010 Questionnaire

8 Yes, by a provider in the Cayman Islands Yes, covered by C.I. Government Frequency Percent Valid Percent Cumulative Percent 32, , Yes, by some other provider 2, Uninsurable No 6, DK/NS Total 53,

9 Analytical Framework: Demand for Insurance Standard model: D(Insurance) = F (Prices, Health Risk, Socio-Demographic Factors, Ability to Pay) Employment-based mandatory insurance model D(Insurance) = F (Employment Agreement) Contractual arrangements determines the latter s enrolment in an insurance plan. May depend on prevailing regulations and practices in certain industries, or occupational categories.

10 Analytical Framework: Demand for Insurance Dual insurance market Dm(Insurance) = Fm (Employment Characteristics)

11 Adverse Effect: An employment-based health insurance regulation benefits the employed but this could adversely affect the welfare of the unemployed due to price effect of the mandatory scheme on the demand for insurance by the unemployed.

12 D1 So P1 Po D2 Do Q2 Q2 Qo Q1

13 Insurance Status Sub-population Uninsured Insured Total Age 0-14 years Employed Unemployed Not In the Labour Force Total Insurance Status Sub-population Uninsured Insured Total Age 0-14 years Employed Unemployed Not In the Labour Force Total

14 Insurance Status Total Uninsured Insured Employed fulltime Employed part-time Seeking and available for work NOT seeking, but available for work Permanently sick or disabled At school or a student, without a job Wholly retired from paid work Home duties Other (please specify) DK/NS Total

15 Insurance Status Uninsured Insured Total Employee, Government Employee, Statutory Authority Employee, Government Corporation Employee private Self employed, WITH No employees Self employed, WITH employees Unpaid family business worker DK/NS Total

16 Insurance Status Occupation Uninsured Insured Total Managers Professionals Technicians and Associate Professionals Clerical Support Workers Service and Sales Workers Skilled agricultural, forestry and fishery workers Craft and related trades workers Plant and machine operators, and assemblers Elementary occupations Not Stated Total

17 Industry Uninsured Insured Agriculture, forestry and fishing Mining and quarrying Manufacturing Electricity, gas, steam and air conditioning supply Water supply; sewerage, waste management and remediation activities Construction Wholesale and retail trade; repair of motor vehicles and motorcycles Transportation and storage Accommodation and food service activities Information and communication Financial and insurance activities Real estate activities Profess'l, scientific and technical activities Administrative & support service activities Public administration and defence; compulsory social security Insurance Status Total Education Human health and social work activities Arts, entertainment and recreation Other service activities Activities of households as employers Total

18 Industry Uninsured Insured Agriculture, forestry and fishing Mining and quarrying Manufacturing Electricity, gas, steam and air conditioning supply Water supply; sewerage, waste management and remediation activities Construction Wholesale and retail trade; repair of motor vehicles and motorcycles Transportation and storage Accommodation and food service activities Information and communication Financial and insurance activities Real estate activities Profess'l, scientific and technical activities Administrative & support service activities Public administration and defence; compulsory social security Insurance Status Total Education Human health and social work activities Arts, entertainment and recreation Other service activities Activities of households as employers Total

19 Insurance Status Uninsured Insured Total Diabetes High Blood Pressure Heart Condition Cancer HIV AIDS Asthma Other Sickness NONE DK/NS Total

20 Insurance Status Disability Uninsured Insured Total Sight Hearing Speech Upper Limb (arm) Lower Limb (Legs) Neck and Spine Learning disability Mental Illness Other Illness None Dont Know Total

21 Insurance Status Uninsured Insured Total Caymanian Non Caymanian Total

22 Insurance Status Uninsured Insured Total $0 - $ $9,600 - $19, $19,200 - $28, $28,800 - $38, $38,400 - $57, $57,600 - $86, $86, DK Total

23 Insurance Status Uninsured Insured Total Male Female Total

24 Insurance Status Age Uninsured Insured Total Total

25 Industry Uninsured Insured None COEA, Entry Level/Common Entrance CSE, CXC Basic GCE/GCSE/IGCSE "O Level/CXC General (1 or 4 subjects) GCE/GCSE/IGCSE "O Level/CXC General (5 or more subjects) High School Diploma or Equivalent Certificate GCE 'A' Level/CAPE/HSC/HND ( 1 or 2 subjects) Insurance Status Total GCE 'A' Level/CAPE/HSC/HND (3 or more subjects) Vocational/Trade Certificate or Diploma Associate Degree Bachelors Degree Postgraduate Certificate or Diploma Masters Degree (Medicine, Law, ) Earned Doctorate (Ph. D.) Professional Qualifications (Computer, Law, Accounting) Other (please specify) DK/NS Total

26 Binary Logistic Regression Results: Population B S.E. Wald df Sig. Exp(B) SEX STATUS DISABILITY ILLNESS NOT WORKING AGE UNEMPLOYED NOT IN LABORFORCE Constant B S.E. Wald df Sig. Exp(B) SEX STATUS DISABILITY ILLNESS NOT WORKING AGE UNEMPLOYED NOT IN LABORFORCE AGE Constant

27 Binary Logistic Regression Results: Working Age Population VARIABLES B S.E. Wald df Sig. Exp(B) SEX STATUS AGE EMPLOYED PARTIME NOT EMPLOYED NOT SEEKING BUT AVAILABLE PERMANENTLY SICK OR DISABLED STUDENT WITHOUT A JOB RETIRED FROM PAID WORK HOMEDUTIES OTHER EMPLOYMENT WITH ASSOCIATE DEGREE OR HIGHER Constant

28 Binary Logistic Regression Results: Employed SKILLED AGRI, FORESTRY & FISHER WORKERS B S.E. Wald df Sig. Exp(B) CRAFTS & RELATED TRADES PLANT & MACHINERIES OPERATORS ELEMENTARY OCCUPATION SERVICE AND SALES WORKERS CLERICAL SUPPORT TECHNICIANS AND ASSO PROF PROFESSIONALS SEX AGE STATUS ILLINESS DISABILITY ASSOCIATE DEGREE AND HIGHER Constant

29 Binary Logistic Regression Results: Employed B S.E. Wald df Sig. Exp(B) SEX AGE STATUS ILLNESS DISABILITY ASSOCIATE AGRI, FORESTRY AND FISHERY MINING AND QUARRYING MANUFACTURING WATER CONSTRUCTION WHOLESALE AND RETAIL TRANSPORT & STORAGE HOTELS & RESTAURANTS COMMUNICATION FINANCIAL SERVICES REAL ESTATE ADMINISTRATIVE SUPPORT PUBLIC ADMIN & DEFENSE EDUCATION HEALTH & SOCIAL SERVICES OTHER SERVICES HOUSEHOLDS AS EMPLOYERS Constant

30 In Summary Preliminary results suggest: Significant under-enrolment of sub-populations that are not fully employed, particularly the unemployed Among the employed, there is significant variation in enrolment by industry and by occupation > the highest compliance seems to the most formal or white collar occupations Policy implication: Industry-tailored, rather than generic enrolment campaigns and compliance monitoring Aggressive enrolment campaign among the unemployed

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