Health unaffordable? Not if the Netherlands steps in

Jan Huurman, former Inspector General of Health in Curaçao, responds to the report of the parliamentary inquiry committee HNO, stating that the financial burden of the Curaçao Medical Center (CMC) hangs like a millstone around Curaçao's neck. Huurman advocates for transferring the financial responsibility of the CMC to the Netherlands. He believes this would not only ensure the continuity of healthcare in Curaçao but also improve the quality of healthcare services. He proposes introducing a consensus Kingdom Act, making the health sector in Curaçao and Bonaire a joint responsibility at the Kingdom level. According to Huurman, this is legally straightforward and necessary to prevent impending financial and healthcare disasters. 

Opinion by Jan Huurman 

The parliamentary inquiry committee HNO has published its report with clear conclusions: the additional costs for Curaçao's new large hospital can be attributed to years of foolish, politically motivated decisions. Yes, more than one factor or person can be blamed (including the Parliament itself), but the shift from the Amstel site to Otrobanda, driven by Ben Whiteman's populism, is the main cause. 

It is very good that a parliamentary inquiry was held (despite all the criticisms of the process), and it is also very good that it is now precisely documented how this situation came to be. Combined with previous reports from the Court of Audit, decision moments, political considerations, and the stark numbers are clear for everyone. 

There are many lessons to be learned, although too much optimism at this point threatens to become another illusion. But what now? Equally important for the coming period is answering the question: how will Curaçao deal with the huge annual losses and the accumulated debt of the Curaçao Medical Center? 

The committee itself says at the end of the summary: "If the current hospital is not enabled to stand on its own feet, the situation will be unmanageable. It is very urgent that a solution is found in the short term to make the hospital sustainable for the future. Any attempt to do so is wholeheartedly supported by the Parliamentary Inquiry Committee HNO." Well: a proposal for this is outlined in this article. 


Before the start of the public hearings by the inquiry committee, I argued in an article published in Amigoe on December 18, 2023, that the financial burden of the CMC hangs like a millstone around Curaçao's neck and poses a serious threat to the quality of public health. 

Recent reports of a significantly reduced loss at the CMC suggest that the situation is improving, but once again, this is an illusion. The hospital's management, supported by the accountant, clearly states that the debt has now risen so high that the continuity of the healthcare facility is at risk. 

Additionally, the reports about transferring ownership of the CMC building from CMC real estate to the Government of Curaçao only create more confusion. It's like a shell game. The situation is very serious. The presented figures and plans also conceal the fact that since the hospital's opening, the maintenance fund has been drained year after year to support daily operations. 

In other words, even if the CMC doesn't go bankrupt in the coming years, the building and equipment will deteriorate and fail, ultimately resulting in a dysfunctional healthcare institution. The parliamentary inquiry committee uses the same words I did in December last year: the CMC is a millstone around Curaçao's neck. 

To remind everyone: SEHOS closed in 2019 after 164 years of operation with a final debt of 118 million guilders. It was widely proclaimed that the hospital was technically bankrupt. The current CMC has been operating for over four years now. In that short time, it has accumulated a debt of 264 million guilders. The CMC is therefore already technically bankrupt to the second power. And the debt increases each year by more than 60 million guilders. Eventually, this debt will have to be repaid, and the annual deficit will need to be covered. 

The Netherlands 

Earlier, I pointed out a potential escape from this dead-end situation: transfer the burden to the Netherlands. In my opinion, there are several reasons to support this. Firstly, because the Netherlands bears co-responsibility due to frequently turning a blind eye—read: the naivety of the Financial Supervision Committee—but also because a well-functioning CMC is in the interest of the Kingdom's residents. This includes not only the citizens of Curaçao but also those of Bonaire and Aruba. Historically, the healthcare sectors of Bonaire and Curaçao have been closely intertwined, as recently reaffirmed by the recent air ambulance debacle on Bonaire. 

How can this burden be transferred to the Netherlands? Politically, it will not be easy, but legally it is not too complicated. Two things need to be arranged: firstly, control over the CMC, and parallel to that, responsibility for public health in Curaçao. 

The latter might seem surprising, but upon closer analysis, it is logical and necessary. From the outset, there has been a link between the additional costs of the CMC and the financial structure of the rest of the healthcare system. The illusion was created that a beautiful new building (which the CMC undoubtedly is!) would more or less automatically lead to savings in other parts of healthcare. 

After countless committees and task forces, reality has set in: that will never happen. The forces and interests in healthcare (pharmaceutical importers, laboratory owners, medical specialists) are too powerful to be controlled within the (small) island culture of Curaçao. 

This same culture makes it impossible for the quality of care to keep pace with the high costs of healthcare. Those who strive for good care are opposed or driven away, while those who go along with the flow survive. The end result of all this: healthcare that is far too expensive with an abysmal quality level. 

October 10, 2010 

In the lead-up to October 10, 2010, much discussion revolved around which sectors would fall under the responsibility of the new 'countries' and which would remain at the level of the Netherlands Antilles or the Kingdom. During these discussions, the option to jointly manage the healthcare sector was explicitly considered. 

The history of the past decade and a half proves how much better that option would have been compared to the route ultimately chosen. With the unbearable burden of the CMC and the inescapable responsibility of the Kingdom (read: the Netherlands) as acute reasons, it is now time to correct the mistake of October 10, 2010, even if only partially. 

Partially because a complete correction for the entire former Netherlands Antilles (thus including Aruba and Sint Maarten) is a step too far. The reason for this highly necessary repair is the Curaçaoan problem, so the intervention can initially be limited to that. The way forward, as mentioned, is relatively simple from a legal (constitutional) standpoint. 

The Netherlands assumes the financial burden of the CMC and the rest of the healthcare system and agrees, through a consensus Kingdom Act with the government of Curaçao, that the healthcare sector in Curaçao and Bonaire becomes a shared responsibility at the Kingdom level. 

This would be similar to the consensus Kingdom Acts for the Coast Guard and the Joint Court of Justice. Financing and the quality of care would no longer be subject to political games in Curaçao. Integration of healthcare on the two sister islands, Bonaire and Curaçao, becomes a real perspective. Approval by the parliaments of the Netherlands and Curaçao is all that is needed for this step, making a revision of the Charter unnecessary. 

Political Influence 

For the CMC, it is crucial to free its governance from the political influence of the Curaçaoan government. Currently, the government has ultimate control through its appointment rights in the boards of directors of both the CMC operating and real estate entities. 

The involvement of the current Minister of Health and the ongoing public disputes highlight the detrimental effect of this influence, especially with the imminent departure of the current Chairman of the Board of Directors. 

It is highly undesirable for Gilbert Martina to be succeeded by someone who is under the thumb of the Curaçaoan minister. This issue can be relatively easily addressed by stipulating in the Kingdom Act on healthcare for Curaçao and Bonaire the creation of a new legal entity (foundation) that will own the two CMC foundations. 

This new legal entity will have a board appointed by both the Netherlands and Curaçao. Through this structure, the Netherlands can have a say in selecting the new head of the CMC and keep financial oversight. This approach can prevent the looming financial disaster for the CMC and the overall healthcare system in Curaçao. 

No, this is not Dutch arrogance or a matter of "he who pays the piper calls the tune," but a shared responsibility for ensuring good healthcare for the residents of Curaçao. The Netherlands can and must prevent healthcare in Curaçao from becoming unaffordable.