Brug Responds to Cft warning on healthcare financing, new SZV board members appointed

GREAT BAY--Minister of Public Health, Social Development and Labor (VSA) Richinel Brug has responded to the Committee for Financial Supervision (Cft)’s recent warning about the unsustainability of Sint Maarten’s healthcare funds, emphasizing that reforms cannot hinge on a single measure. He confirmed that discussions with the Cft last week were “serious but fruitful,” with both parties agreeing that a mix of initiatives must be pursued simultaneously to safeguard the system.

“I share the Cft’s concerns,” Minister Brug said. “For too long there has been this political notion that the approval of the draft general health insurance legislation is the solution to saving the funds and improving quality of healthcare. While important, it is just one of many initiatives that must be implemented together to ensure a more sustainable future for Sint Maarten.”

During the meeting, Minister Brug highlighted additional measures under consideration:

• Finalizing the long-overdue L-tax and establishing a structured repayment plan,

• Ensuring employers register all employees, including those currently unregistered,

• Introducing cost containment policies, such as stricter controls on medical referrals abroad,

• Promoting preventative healthcare to reduce long-term costs,

• Strengthening governance by ensuring SZV’s Supervisory Board is properly staffed, in line with legislation.

The Minister noted that the Council of Ministers has confirmed the appointment of three new SZV board members, with the process to fill two more ongoing. He also underscored the importance of financial accountability, pointing out that for the first time since 2017, SZV’s amended 2025 budget and its 2026 budget have been officially approved by government. As part of this approval, SZV was instructed to identify organizational cost-cutting measures and submit proposals by April 1, 2026.

“This is a clear signal that reform is not optional, it is urgent,” Brug said. “A number of initiatives must take place simultaneously for us to keep the funds sustainable and ensure a healthier St. Maarten. I will soon disclose additional measures, developed together with the Cft, to improve conditions at SMMC and strengthen the entire healthcare system.”

Earlier this week, the Cft issued a stark warning that Sint Maarten’s healthcare system is financially unsustainable. Between 2010 and 2023, cumulative deficits in the healthcare funds managed by SZV reached roughly XCG 500 million. With annual shortfalls of XCG 30–35 million, currently covered by AOV reserves, the IMF projects that liquid reserves could run out by 2029.

The Cft has long called for the introduction of a general health insurance system (GHI/SAAHA) to broaden the contribution base and better control expenses. It also urged implementation of measures already identified, such as greater use of generics, reducing referrals abroad, and strengthening family medicine clinics. Beyond healthcare, the Cft has criticized budget delays, reminding government that the 2025 budget was adopted more than six months late and urging timely adoption of the 2026 budget.