Cft Warns: Financing of St. Maarten healthcare system not sustainable

GREAT BAY--The Committee for Financial Supervision (Cft) has issued a stark warning that Sint Maarten’s healthcare system is on an unsustainable path if urgent reforms are not implemented. For more than a decade, the country has faced structural deficits in its healthcare funds, and without corrective measures, the financial situation threatens both the social security system and public finances at large.

The deficits, managed by the Social and Healthcare Insurance Executive Organization (SZV), have reached alarming levels. Between 2010 and 2023, cumulative losses in the healthcare funds totaled approximately XCG 500 million. Looking ahead, SZV projects annual shortfalls of XCG 30 to 35 million, currently offset by surpluses from the old-age pension fund (AOV). However, these reserves are being depleted rapidly, with the International Monetary Fund warning that liquid reserves could run out as early as 2029.

According to the Cft, the imbalance between income and expenses is the core issue: healthcare costs structurally exceed contributions. With an aging population driving demand upward, the Cft emphasizes that a sustainable system requires everyone to contribute their fair share. It has long urged Sint Maarten to finalize and implement a general health insurance system (GHI/SAAHA), which could increase premium income and better control expenses. Yet, despite being in development for more than ten years, the legislation remains incomplete.

The Cft is calling on all stakeholders—including the Ministers of Public Health and Finance, SZV, and the St. Maarten Medical Center and new General Hospital—to accelerate cooperation and reforms. It also stressed the need to implement measures already identified, such as expanding the use of generic medication, strengthening family medicine clinics, and reducing costly medical referrals abroad.

On fiscal governance, the Cft criticized delays in budget approval. The 2025 budget, due in December 2024, was not adopted until July 10, 2025, more than six months late. With the 2026 budget now in preparation, the Cft urges Sint Maarten to ensure its timely adoption before the start of the new year as an essential step toward restoring sound financial management.

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