The Cayman Islands (CIs) are unique in many aspects, but among them is the size of the nation compared to the sophistication of the business and government processes. With a population of only 50,000 people, they are roughly the same size as a rural community in the United States — ranked 201st on the size of countries by population.
But the CIs government processes and business acumen are far more advanced than their size would lead some to believe. Their history of financial management skills — the Islands manage $1.5T (as in trillion) in assets — is underwritten by a culture that is forward thinking and embraces risk. The relatively small size of the population supports an agile government process that can move quickly to react to changing cultural and economic issues.
It is worth noting that there is no income tax in the CIs — one of only six countries in the world with that tax model (and those other countries are dominated by oil-producing economies). Without any substantial exports, the Cayman Islands society has managed to prosper for over 200 years on this model, including the provision of an impressive healthcare service. I’m convinced that the tax model and the healthcare system are applicable to any nation, regardless of size. In fact, in larger countries like the U.S., where imports and exports are a substantial part of the economy, the tax model and healthcare operational model would function even better.
The healthcare system in the CIs is already advanced by U.S. standards. Health insurance, like car insurance, is required by law, so everyone is managed in a defined risk pool. A national insurance corporation and healthcare system provide all levels of care for approximately 70% of the country, with the remainder provided by private practice and payers. Thus, choice is accommodated, but care is ensured.
In November, the Cayman Islands Ministry of Health sponsored an international conference on healthcare reform, with the intent of further defining an already existing path of change towards a high quality, economically sustainable healthcare system for the nation. Here’s a link to the speakers: Healthcare 2020 Conference. I presented a lecture about the role of information technology and electronic medical records in healthcare transformation, but I also spent a good deal of time talking about fundamental business models and motives because technology alone is simply white wash on a dirty fence. Here’s a link to those slides: Role of Technology in Healthcare Reform.
The essence of the message is simple:
Healthcare Transformation = Sustainable Business Models x Electronic Medical Records
While we are all enamored by the HIMSS conference, Meaningful Use and HITECH, if we — the U.S. — don’t address fundamental and sustainable economic models with as much enthusiasm as we have the technology, transformation will fall far short. We are, at present, adopting technology which is largely based on old economic models. The speed of economic reform, primarily reimbursement models, must exceed the speed of technology adoption in healthcare.
Contrary to popular anthropological belief, we are not Homo Sapiens. We are Homo Economicus and our behaviors are primarily driven by our desire to gain additional wealth, usually at the expense of others. Change the economic model and you change the behavior, regardless of what you do with technology.