~ Financing not sustainable, serious concerns uncovered ~
PHILIPSBURG--Minister of Public Health, Social Development and Labor VSA Veronica Jansen-Webster on Wednesday made it clear that she did not close the House Doctor After-Hours Practice (HAP) Huisaartsen Post which was being executed at the St. Maarten Diagnostic Center (SMDC) in Simpson Bay. HAP provided non-emergency medical care after hours.
The Minister explained that the contract for the HAP is between Social and Health Insurances SZV and the HAP and indicated that serious concerns were uncovered during an evaluation of the service including inconsistency of prescriptions and billing from the St Maarten Diagnostic Center and the HAP, which she said raised further red flags. She said also that the financing was not sustainable.
Allowing the HAP to continue operating in the manner it was, the minister noted, would continue to cut deeply into the country’s healthcare budget and ultimately undermine the quality of care that residents deserve.
“Let me be abundantly clear, I did not close anybody down,” Jansen-Webster said during the live Council of Ministers press briefing.
The Minister explained that the HAP was launched as a pilot project in June 2023 as a six months project followed by an evaluation of the project to determine how to proceed. The contract was extended by another six months by Social and Health Insurances SZV right before the election in December 2023. “When I assumed office, SZV was already preparing to terminate the service because of irregularities discovered in the billing of the HAP,” she explained.
“SZV informed the HAP one week before the end of the second contract that they would discontinue the contract because the financing of the project was not sustainable. However, knowing how important the community deems the HAP, I asked SZV to give the HAP a chance to address the serious allegations and operational irregularities they were facing with an extension of three months so that the SZV audit could be finalized and a thorough evaluation could be done so that we could see how to proceed in the best way for everyone.”
She said a meeting was held amongst her, Dr. Dennaoui and SZV on June 18, to discuss the points of improvement and the way forward.
To ensure a fair evaluation, Jansen-Webster commissioned a special evaluation committee, composed of individuals with diverse expertise from within the Ministry and relevant stakeholders. After receiving the report from this evaluation committee, SZV proceeded to issue the notice of termination of the HAP.
“After the notice was sent, I was informed of the letter that was sent. In good faith, I extended the HAP’s contract by three months, hoping they would rectify their issues. Furthermore, I initiated a thorough review by an evaluation committee, which included the operators of the HAP and presented its findings and recommendations on September 3.”
She said the evaluation revealed serious concerns. She said there was no clear distinction between after-hours general practitioner GP services (so the HAP) and regular diagnostics centre services. There was reportedly no significant decrease observed in emergency numbers at St Maarten Medical Center (SMMC).
There was no liability insurance, which presents a significant risk, not only for the community, but especially for our fragile tourism industry. Additionally, there were no internal protocols for triage, so for determining the urgency of medical cases and the inconsistency of prescriptions and billing from SMDC and the HAP raised further red flags. It could not be determined through which
company SZV was being billed.
“Despite the St. Maarten Diagnostics Center’s and the MP’s [Omar Ottley – Ed.] claims, the data received by the committee does not support that the HAP has significantly reduced the burden on the emergency room. Even with 7,000 persons using the service – 83% of whom were covered under SZV – the numbers still did not show a substantial impact on emergencies,” said Jansen-Webster.
She said the evaluation points more in the direction of authorities perhaps having to explore options to extend regular GP hours instead.
“It is again unfortunate that politics seems to be played with an issue as sensitive as this. In his statement, the former minister suggested that the closure of the HAP could lead to a public health crisis. Let me be clear: allowing the HAP to continue operating in the manner it was would continue to cut deeply into our healthcare budget and ultimately undermine the quality of care that our citizens deserve. Irresponsible management of public health funds is more likely to lead to a public health crisis than closing an operation that fails to meet critical standards,” said the minister.
“I can stand here today and politicise as well, I can show you emails that were sent to me by the Doctor following our June 18, meeting threatening to go to the media if I decide to close the HAP followed by an apology. The Doctor and the former Minister of health/current MP also hosted a radio programme together three days before elections in which they indicated that I was closing the HAP and a vote for me would be a vote for the closure of the HAP. This radio appearance was also followed by another apology letter from the doctor. I will reiterate that the contract is between SZV and HAP.”
The minister believes in the value of a well-functioning HAP and said government knows that it is needed, she said however that “it must meet its obligations and operate within the agreed-upon standards. We cannot tolerate mismanagement at the expense of public health. It is again unfortunate that politics seems to be played with an issue as sensitive as this.”
