Outcomes - Selected Case Summaries



HSA patient referrals policy

Early Resolution | 22 April 2022
Health Services Authority (HSA)

This complaint sought to determine the Cayman Islands Health Services Authority’s (HSA's) policies with regard to patient referrals made by HSA doctors via CINICO health insurance for patients needing outside specialist care from private sector providers. The complainant in the case noted that the HSA changed its policy on patient referrals, but that it had not published this policy or notified local doctors regarding what is required to comply with it. It was stated that this uncertainty affected several patients and their families who were worried about being unable to continue to receive care.

We sought to resolve this issue informally before proceeding with a formal investigation and sent some questions to the HSA. Initially, our questions were not responded to. However, a series of queries sent earlier by the complainant were responded to in writing following our request.

There also appeared to have been some miscommunication between the parties, as an HSA representative noted that private sector medical providers had already been contacted about the changes in the policy and that a written document would be ready sometime later.

Attempting to move the situation along, our office mediated a meeting between the complainant and several HSA representatives with an eye toward seeking to resolve the matter There were some contentious issues discussed, but none of those had any relevance to the complaint in the end. It was agreed by the HSA that they would seek to produce a draft policy for patient referrals within the next 30 days of the meeting, having taken input from service providers. The HSA produced the written policy several weeks later and sent it to the medical care providers (including the complainant). The complainant agreed to close the complaint.

Given that no investigation into this matter took place, the Ombudsman made no recommendations.