WILLEMSTAD – The Curaçao government has rejected demands for an immediate increase in the annual reimbursement paid to family doctors, arguing that the proposed adjustment would add more than XCG 4 million to healthcare expenditures each year and must first be evaluated through an independent cost assessment.
Health Minister Tyron Boekhoudt outlined the government's position in a statement issued on November 2, 2026, as a dispute over general practitioners' compensation escalated into a nationwide strike.
The Curaçao General Practitioners Association (CHV) is requesting a temporary increase of XCG 30 per registered patient per year to compensate for rising operating costs.
The doctors have indicated that they would accept the temporary adjustment for a maximum of two years, provided that the Regulatory Authority of Curaçao (RAC) completes its cost analysis within that period and establishes the basis for a permanent tariff adjustment.
However, the government maintains that the proposed increase cannot be approved without first examining the actual costs of operating medical practices.
Government Says Independent Cost Assessment Is Necessary
According to the ministry, all requests for higher healthcare tariffs must be evaluated by the RAC before the government can determine whether an increase is justified.
The government argues that this is particularly important when reimbursement adjustments are intended to cover practice expenses.
Not all operating expenses, the ministry maintains, can automatically be attributed to the legitimate costs of providing patient care.
For that reason, the government considers an independent assessment necessary to establish which expenses should be reflected in the reimbursement structure.
Boekhoudt says this approach is consistent with the government's longstanding policy for evaluating healthcare tariff increases.
The ministry objects to the doctors' decision to suspend regular consultations while demanding an interim increase before returning to work.
The CHV, meanwhile, argues that further delays are unacceptable after years without the tariff indexation agreed upon in May 2012.
How Much Do Family Doctors Currently Receive?
The government's statement provides a detailed explanation of the existing reimbursement system.
According to the ministry, the Social Insurance Bank (SVB) currently pays family doctors approximately XCG 182 annually for every patient registered with their practice.
Curaçao has approximately 140,000 residents insured under the Basic Health Insurance system (BVZ) and 87 family doctors registered with the SVB as participating healthcare providers.
Based on those figures, the government estimates that the average family doctor has approximately 1,600 registered patients.
An average-sized practice therefore receives approximately XCG 291,000 annually in capitation payments, equivalent to about XCG 24,300 per month.
For a single-doctor practice, the maximum number of registered patients is 2,500.
A practice of that size could receive approximately XCG 455,000 annually, or around XCG 38,000 per month, through the basic SVB reimbursement system.
The ministry also points out that family doctors can receive additional payments for certain services, including home visits.
However, these figures represent gross practice reimbursements rather than the personal take-home income of individual doctors.
The amounts must also cover applicable operating expenses, which may include personnel, equipment, premises, administration, and other costs associated with maintaining a medical practice.
The government has not provided a detailed breakdown of those expenses in its statement.
Government Argues Emergency Post Has Already Improved Doctors' Compensation
A central part of the government's argument concerns the introduction of the General Practitioners' Emergency Post, known as HAP.
Before the establishment of the HAP, family doctors were responsible for providing or arranging care for their patients 24 hours a day, seven days a week.
Since January 1, 2024, the HAP has assumed responsibility for after-hours care from 5:00 p.m. until the following morning, as well as during weekends and public holidays.
The government says it fully finances the operation of the emergency post.
According to the ministry, this arrangement has substantially reduced the number of hours during which individual family doctors are responsible for their registered patients.
Nevertheless, the doctors continue receiving the same basic annual SVB reimbursement.
The government considers this a financial improvement because the reimbursement has remained unchanged while the doctors' after-hours responsibilities have decreased.
It argues that the arrangement should be regarded as an effective adjustment to the basic compensation structure.
The CHV's demand, however, focuses on the increasing costs of maintaining medical practices, rather than solely on the number of hours doctors remain responsible for patient care.
Doctors Receive Payments Even When Patients Do Not Visit
The government also emphasizes that the capitation system provides doctors with a fixed annual payment for every registered patient, regardless of how often that patient visits the practice.
This means that doctors receive approximately XCG 182 per registered patient even when the patient does not require a consultation during the year.
According to the ministry, some registered patients rarely or never visit their family doctors, making the fixed-payment system financially advantageous for practices.
The government uses this argument to support its position that existing reimbursement levels are sufficient.
However, the capitation system is designed to finance access to primary healthcare across an entire registered patient population, including patients who require frequent consultations and those who need little medical attention.
Determining whether the current rate adequately covers the actual costs of delivering those services is precisely the issue the RAC assessment is expected to address.
Disagreement Over Timing Remains Unresolved
The financial dispute centers on whether doctors should receive temporary relief before the completion of the RAC analysis.
The CHV has proposed a limited increase of XCG 30 per patient annually, while the government insists that any adjustment must first be supported by the findings of the regulatory authority.
At approximately 140,000 BVZ-insured residents, an additional XCG 30 per patient would amount to roughly XCG 4.2 million annually, consistent with the government's estimate that the proposal would cost more than XCG 4 million.
The association has requested written confirmation of the temporary arrangement and a concrete timetable for implementation.
The government has not accepted those conditions.
Instead, it maintains that doctors should cooperate with the RAC assessment and continue providing regular patient care while the financial issues are examined.
The disagreement now raises broader questions about the sustainability of Curaçao's primary healthcare financing system.
The government is seeking to control public healthcare expenditures and ensure that tariff adjustments are based on documented costs.
Family doctors argue that operating expenses have continued rising while their reimbursement structure has remained insufficiently adjusted for more than a decade.
A lasting resolution will require agreement not only on the appropriate reimbursement rate but also on the timetable for completing the cost assessment and implementing any necessary changes.
Until then, the financial dispute between the government and family doctors remains unresolved, with the potential consequences extending beyond medical practices to the patients who depend on their services.