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SABA:--- The Executive Council has submitted a letter to the Dutch Parliament in which it expressed serious concerns about the deficient curative healthcare for Saba residents. Saba is calling for direly needed changes to the healthcare system to ensure good curative care for the people. The two recent deaths of patients on St. Eustatius underscore this need.

As you know, our neighboring island Statia was shaken in recent weeks by the unforeseen death of two residents. These events have a huge impact on all those directly involved, on Statias general population and also affected the people on Saba, it was stated in the letter to the members of the First and Second Chamber who recently visited Saba on Monday, May 2. The Executive Council and the Island Council also brought up the healthcare issues in the meeting with the parliamentary delegation.

In the letter to the Parliament, the Executive Council stated that it was pleased that a number of Members of Parliament (MPs), including Jorien Wuite of the Democratic Party D66 and Roelien Kamminga of the liberal democratic VVD party, submitted written questions about the recent events, the accessibility of curative special care and the Caribbean Netherlands healthcare system in general.

Little response

The Public Entity Saba regularly highlighted concerns regarding the provision, accessibility, continuity and the quality of healthcare. So far, we have experienced little response. The recent sad events have led to a sense of urgency. We expect that the investigations of both incidents on Statia will lead to recommendations for all stakeholders. The Public Entity Saba wishes to emphasize that this moment should be used to make the necessary and sustainable changes to ensure the best possible curative care for the Statia and Saba inhabitants.

In the letter, the Executive Council also addressed a number of pressing issues with regard to the curative healthcare profile and services, (temporary) uninsured residents, and medical referrals. The Public Entity Saba has intensified consultations with the Ministry of Public Health, Wellbeing and Sport (VWS) to discuss the challenges.

Many challenges

The many challenges include: the availability of care on the island, the accessibility of off-island specialist care, the follow-up of medical referrals, the conditions of medical transport, the communication of the Health Insurance Office ZVK, the availability of correct information for patient and medical professional, the possibility of a second opinion, the right to a companion during travels for medical treatment abroad, the content of the insurance package and the availability of population screening programs.

The issue of being uninsured under the ZVK when persons move to Saba for work or other reasons requires urgent addressing. It was explained in the letter that health insurance registration can only take place when the person is registered at the Census Office, which in turn can only take place when a person has received a residence permit. The residency permit process by the Immigration and Naturalization Department (IND) can take up to several months, a period during which the resident is uninsured through ZVK.

Unlike in the Netherlands, Saba has no access to a special fund to which a healthcare organization can turn when a person is uninsured and cannot pay the bill. In recent month, the Public Entity Saba has guaranteed and paid bills for necessary care and off-island transportation of a patient who resettled on Saba.

Timely manner

The local government is further questioning the use of the ZVK medical advisor as the one who ultimately approves the medical referral as this can contribute to delays in the medical referral process. It is generally felt that patients need to be receive medical assistance abroad in a timely manner and the logistics surrounding medical referrals should run smooth. Having decisions take place at the ZVK back office on Bonaire instead of at the ZVK office on Saba as before is not beneficial to patients. Saba wants the authority of medical referrals, including the handling of appointments, restored to the local ZVK office.