PHILIPSBURG — The costs for health care services to so-called PP card holders are more than ten million guilders higher than budgeted, it appears from a compliance audit by the General Audit Chamber.
The auditors are quit critical of the system, noting that PP stands for pro pauper, meaning: for the poor. Their report suggests that the government changes this derogatory name.
But there is more: to be eligible for a PP card, residents have to earn less than 3,758 guilders ($2,099) per month. That is equivalent to the average monthly household income of 68 percent of all households in St. Maarten. “Classifying two-thirds of households as pro pauper does not strike us as appropriate,” the report states.
A crucial element is the budget shortfall. In 2021, expenditures for PP card holders were 22.8 million guilders ($12.7 million) while the budget was only 13.7 million guilders ($7.6 million). In 2023 those expenditures went up to 24.6 million guilders ($13.7 million). The annual budget deficits “are due to the government’s failure to adjust the budget based on previous actual budget results,” the auditors observe.
The auditors furthermore found that the communication between health insurance agency SZV and the Ministry of Public Health, Social Development and Labor (VSA) is inadequate and that this results in the lack of understanding the costs of the PP card program. Even better: it is unclear how many citizens are PP card holders. The auditors put this question to the labor department, the Ministry of VSA and to SZV but none of them came up with an answer.
The Audit Chamber concludes that “inadequate financial management, a lack of transparency and ineffective communication complicate the current financial situation and the implementation of medical assistance.”
The report furthermore notes that the parliament and financial supervisor Cft authorize the budget deficits.
The National Ordinance Medical Assistance regulates medical care for those who cannot afford it. A PP card entitles its holder to the same medical care as government employees.
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Related press release: General Audit Chamber identifies critical shortcomings in the Medical Assistance Program
Download the complete audit report here>>>
Opinion piece: The trouble with PP cards
By Hilbert Haar
If you thought that your private bookkeeping is a bit messy, think again and read the compliance audit the General Audit Chamber conducted into medical assistance.
Sadly, there are citizens who cannot afford medical care and for those citizens, the government has a solution: the National Ordinance Medical Assistance. Great, isn’t it?
If you cannot afford, for whatever reason, to pay for your medical care you can get a so-called PP card from the government. That card entitles its holder to the same medical care as government employees. Sounds good, right?
There are however a couple of painful problems and they begin already with the name. PP stands for pro pauper which means, in case you did not get it, for the poor.
Therefore, it is tempting to think that PP cardholders are poor people. But is that really so? To qualify for the card your monthly income must be below 3,758 guilders, or $2,099. I am not arguing the question whether such an income is enough to keep your head comfortably above the water in St. Maarten. The General Audit Chamber does not do that either.
But the auditors do point out that such an income is equivalent to the average monthly income of 68 percent of all households on the island. They add an apt observation to this undeniable fact: “Classifying two-thirds of households as pro pauper does not strike us as appropriate.”
I’m thinking that those auditors have valid point there.
The auditors also wanted to know how many people have a PP card. They asked the labor department. They asked the Ministry of Public Health, Social Development and Labor. And they asked SZV. None of these agencies managed to come up with an answer which makes me think that they simply don’t know how many of these cards are out there.
What we do know however, is that those PP cards cost far more than the budget that is made available for it. This begs the question: are there an awful lot of PP card holders? Or: are there not that many card holders but do they cost the tax payer a disproportionate amount of money?
It is mindboggling that a government that is seriously strapped for cash is unable to provide even the most basic information about a program that costs more than twenty million guilders every year.
Changing the name of those cards from PP (pro pauper, remember?) to something like ETH (Entitled To Healthcare) is obviously not going to solve the underlying problems. It is just a tiny step in the right direction. But it is high time for the bookkeepers and the accountants that are supposed to know where the money goes (and the politicians that are supposed to keep an eye on them) live up to expectations. Better late than never.
