Minister of VSA has decided to discontinue the VSA-SZV-SMMC Tri-partite as it has completed its objective. The Tri-partite was established for the purpose of the construction of the new building, which will house the SMMC. Having consulted with the ministry and with external advisory bodies it has become clear that the tri-partite has concluded its task.
The Tripartite setup:
The VSA-SZV-SMMC tri-partite is based on a protocol that was signed in March 2015 between the then Minister of VSA Mrs. Rita Bourne-Gumbs, Director of SZV Mr. Glen Carty and Director of SMMC Dr. Kees Klarenbeek. The tri-partite was not based on a national decree, rather a tri-partite agreement which is an agreement between three parties. This protocol established consultations to develop the design of a new hospital.
The protocol was between the following three parties each with its responsibilities:
1. The Minister of VSA, responsible to develop and supervise public health policy,
2. the Social and Health Insurances (SZV) charged with the financing of health care services for persons insured by social health insurance funds, government PP-card holders and civil servants,
3. the St. Maarten Medical Center (SMMC) a private foundation providing hospital services
The International Labour Organization (ILO) recommends governments to promote tri-partite consultations according to ILO standards between employer-, employee- and government representatives.
Decisions taken by the VSA-SZV-SMMC tripartite not based on established legal advisory procedures:
According to the Minister, it is established that the VSA-SZV-SMMC tri-partite has taken compromising decisions with far reaching consequences for country St. Maarten and the public health system. This statement is supported by the fact that the Council of Public Health, an official advisory body to the Minister of VSA, in an advice of October 1, 2018 number 2018/111 with as topic: “Tri-partite Minister VSA-SZV-SMMC” reported to the former minister of VSA the following:
1. the Council of Public Health stated that the Council was NOT approached for an advice of setting up such a “tri-partite” constellation. (page 1 of the advice)
2. the following are 3 of the 6 breaches as mentioned on page 3 of the advice:
a. The tri-partite decided to increase the yearly advance from SZV to SMMC since 2006 with 35% without going through the normal advisory trajectory of establishing a national decree concerning general measures for new social tariffs for nursing/medical services;
b. The tri-partite decided to increase SMMC tariffs for the private sector without requesting the required advice to change the current national decree;
c. The fact that SMMC and SZV are decision makers in this tri-partite committee is a conflict of interest. SMMC and SZV were making decisions on matters concerning themselves, while the interests of other stakeholder were not taken into account.
It is evident that the former Minister of VSA and the Tri-partite have made decisions on issues that have far-reaching consequences for public health. These decisions were taken without requesting advice from legal advisory bodies, such as the Council of Public Health, the Social Economic Council (SER) and the Council of Advice.
The Council of Public Health advised the former Minister of VSA to change the constellation of the “tri-partite” and the task of the tri-partite into an advisory committee. The former Minister ignored the advice and did not provide a written motivation to the Council, before deviating from the advice and continuing the original tri-partite constellation. “Disregarding art 15 sub 1 of the National Ordinance concerning the Public Health Council is unlawful, therefore, as the current Minister of VSA, I will inform the Council of Public Health of my decision and my motivation to discontinue the Tri-partite”, states Minister Gordon-Carty.
Decisions taken by the VSA-SZV-SMMC tripartite with far reaching consequences for public health:
The Social and Economic Council (SER) in its advice of April 17, 2018 (ref no: SER/18/BP/11) gave a negative advise on the 41.83% tariff increase at SMMC.
1. “The SER does not agree with the indexation of 41.83%..”. (Page 1)
2. “The SER advices the government to recalculate the medical and nursing tariffs before the end of the year 2019” (Page 2)
3. “the national decree medical and nursing tariffs (AB 2013 GT no. 53) determines that SMMC may not charge a higher fee for medical and nursing services than those agreed upon…”(page 3)
4. SER expresses some concerns as: “The SER does not agree with the way the adjustments is being calculated………these tariffs should be recalculated instead of just being indexed”(Page 5)
5. SER continues to express concerns by stating: “ The SER underlines that “if the cost of delivered services is significantly higher than government approved tariffs, it will have a negative impact on the QUALITY of services as well as on the sustainability of SMMC” (Page 5)
6. “Any increase , especially an immediate increase of more than 40% will have consequences which may negatively influence the SOCIAL AND ECONOMICAL WELFARE OF ST. MAARTEN, especially considering the effects of the passing of the hurricane Irma has on the social economic landscape” (Page 7)
Minister of VSA Pamela Gordon-Carty continues to state that in various public statements, the St. Maarten Consumers Coalition has also expressed their concern about the tariff increases at SMMC and transfers made by SZV absorbing higher tariffs without an amendment of the national decrees.
“After objectively considering the reports and information received from relevant stakeholders mentioned above, I understand the negative impact of continuing with the Tri-partite in its present form”, says Minister Gordon-Carty.
On the 27th of December 2019 as Minister of VSA, accompanied by some of my advisors, I consulted the members of the coalition in government and in parliament about the above mentioned findings and about my decision to discontinue the participation of the Minister of VSA in this Tri-partite. The fact that the purpose for the existence has also already been realized (the design of a new hospital and a business plan), I have informed the Director of SZV and the Director of SMMC of my decision not to continue the Tri-partite as agreed. Government will continue consultations with SMMC and SZV. There are existing advisory bodies, which have to consult with SMMC as a health care institution and with SZV as the social and health insurances executing agency. “Furthermore, I emphasize that any stakeholder in the public health sector is welcome to approach the Ministry of VSA for information or dialogue on improvements of the health care system in St Maarten”, concludes Minister Pamela-Gordon-Carty.