What a collapse of St. Maarten’s health care system would mean

GREAT BAY--St. Maarten’s health care system is edging toward the brink.  For more than a decade, the country’s health insurance funds have been bleeding money. The Committee for Financial Supervision (Cft) estimates that between 2010 and 2023, deficits reached nearly XCG 500 million. Unless drastic steps are taken, annual shortfalls of XCG 30 to 35 million will soon devour the reserves of the old-age pension fund, leaving nothing to cushion the blow. The International Monetary Fund projects that liquid reserves could run out as early as 2029.

Let’s put that trajectory into perspective. If annual deficits average 32 million guilders, the country adds roughly 320 million in losses every decade. That means that in less than 20 years, well within the lifetime of today’s young working population, St. Maarten could be staring at a billion-guilder deficit in its healthcare and social insurance system. In fact, some people predict that a collapse, without real intervention, could occur in the next 5 years.

That number represents money that will not exist to pay for hospital care, pensions, medication, or basic public services. It represents broken promises to workers who spent their careers contributing to a system that collapses under them.

So, what would that look like? A collapse would not be a slow unraveling. It would look like a sudden freefall. Governing would be crippled immediately.

• 𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥𝐬 𝐮𝐧𝐚𝐛𝐥𝐞 𝐭𝐨 𝐩𝐚𝐲 𝐬𝐮𝐩𝐩𝐥𝐢𝐞𝐫𝐬. Medicine shortages would become routine, forcing doctors to ration care. Treatments considered standard today, dialysis, cancer therapy, even certain surgeries, could grind to a halt.

• 𝐒𝐭𝐚𝐟𝐟𝐢𝐧𝐠 𝐝𝐫𝐚𝐢𝐧𝐞𝐝 𝐛𝐲 𝐦𝐢𝐠𝐫𝐚𝐭𝐢𝐨𝐧. Nurses and specialists, unpaid or underpaid, would leave for Curaçao, Aruba, or the Netherlands. Clinics could close their doors.

• 𝐌𝐞𝐝𝐢𝐜𝐚𝐥 𝐫𝐞𝐟𝐞𝐫𝐫𝐚𝐥𝐬 𝐚𝐛𝐫𝐨𝐚𝐝 𝐜𝐮𝐭 𝐨𝐟𝐟. With no funds to cover costs, patients needing specialized procedures would simply be denied. Families would face impossible choices: pay tens of thousands out of pocket or watch loved ones deteriorate.

• 𝐀 𝐝𝐨𝐦𝐢𝐧𝐨 𝐞𝐟𝐟𝐞𝐜𝐭 𝐚𝐜𝐫𝐨𝐬𝐬 𝐬𝐨𝐜𝐢𝐞𝐭𝐲. A weakened workforce, rising medical debt, untreated chronic illnesses, and a surge in preventable deaths would destabilize every sector. Tourism, St. Maarten’s economic lifeline, would take a hit as health and safety standards falter.

• 𝐏𝐮𝐛𝐥𝐢𝐜 𝐭𝐫𝐮𝐬𝐭. Collapse would also threaten public trust in government institutions. If people believe their pension and health contributions vanish into a broken system, tax and compliance rates plummet, worsening the fiscal hole. Private health care would surge, but only for those who can afford it, deepening inequality.

What is looming for St. Maarten is not unprecedented in the Caribbean. Barbados has had to introduce emergency health levies to keep its main hospital solvent, while in Jamaica patients have at times been told to bring their own gloves, syringes, and bandages to public clinics. Trinidad and Tobago’s public sector has seen years-long waiting lists for surgeries, while Guyana once relied on foreign doctors after local professionals left in droves. If St. Maarten continues on its current path, the country risks repeating these same failures on a smaller, more fragile scale, with fewer options for recovery.

Yet a collapse is not inevitable. The Cft has pointed to clear solutions, long on the table but repeatedly delayed. A general health insurance system (GHI/SAAHA) has been in development for over ten years. If implemented, it would broaden the pool of contributors, raise premium income, and distribute the burden more fairly. The introduction of stricter controls on referrals abroad, greater reliance on family medicine clinics, and increased use of generic medication are measures already identified but left unimplemented.

The reforms are neither glamorous nor politically popular, but the alternative is devastation. A government unwilling to act now is effectively choosing to leave its people vulnerable when the reserves dry up.

Prime Minister Luc Mercelina recently reaffirmed his government’s commitment to resilience in another sector: disaster management. At a high-level meeting with the World Bank, he described the Emergency Operations Center as “a promise to safeguard our country’s future” against hurricanes, floods, and other crises. The same urgency must be applied to health care. Because the real disaster, unfolding in slow motion, may not come from the next hurricane but from within: a health system too broken to protect the very people it was built to serve.

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