PP card regulation labels two-thirds of households as paupers
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
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