The Doctor is in out

By Elvin Bailey

A gentleman told me, in the early stages of our reform discussions, that if we could fix the sickness aspect of Social Security, then the institution is likely to survive. If we don’t, we will have problems. His comment was very insightful. 

The truth in the comment is best understood by those who pay for health care and pay for the cost of sickness. For example, budgetary allocations from the Ministries of Health amount to $55.7million for 2009 ($15.8M for Nevis & $39.9M for St. Kitts). At Social Security, where we replace wages up to $4,225 per month for normal sickness (65% of $6,500), $4,875 per month for employment related sickness (75% of $6,500); repay all medical bills and medical evacuation costs up to a maximum of $25,000 and provide constant care allowance under the Employment Injury Branch, payments amounted to $7.3million for 2008.

Why is there so much sickness, who is getting sick, what are they getting sick from and what is the impact of all this sickness on the nation’s productivity?

Between 2001 and 2008, sickness claims rose from 4,668 to 10,612 and payments rose from $2.04million to $6.5million during the same period. These are increases of 227% and 316% respectively.  When the data is plotted on a graph, the results indicate that the growth is becoming more intense since 2007 for the amount claimed and for days lost; and that it has intensified from 2007. When the data is studied further, we note that many more women than men claimed sickness benefits in 2008 – 7,117 to 3,945. However, when we examine work related (EI claims), we note that for the same year, more men claimed benefits than women: 335 to 203. What do you conclude from this?

There were 233 maladies that affected and afflicted us in 2008. The dirty dozen for women in descending order of observance were Viral Illnesses (13.3%), Influenza (7.4%), Complications of pregnancy (5.6%), Hypertension (4%), Back Pains (3.6%), Surgery (3.4%), Respiratory Infection (3.0%), Abdominal Pains (2% ); Gastro-enteritis (1.8%),  Headaches (1.5%)  and Medical Illness at 1.4%.  For men, their major ailments were Influenza (7.5%), Back Pains (6.4%), Hypertension (3.1%), Lacerations (3%), Surgery (2.7%), Back Strains (2.6%), Lumbago and Arthritis (2.1% each), Respiratory Infections (1.9%), Gastro-enteritis (1.5%), Folliculitis (1.4%) and Gastritis (1.4%).

I recall, at a World Health Organisation meeting that I attended, the Health Minister of Zimbabwe said that humans exist for the modus vivendi of germs. That appears to be particularly true for St Kitts & Nevis.

Is there an age issue to these sicknesses? See for yourself. At all ages, both sexes get sick, but the peak of sickness for men (bottom line) is for those who are 24-29 years, while that peak age for women is 25-29 years (top line). Note that it is not so much the older folks, it is the young, presumably able-bodied workers who are reporting sick! Why this is so may be explained, in part, by the nature of illnesses presented earlier, and by the retirement policy of Government.

Claims related to reproductive health amounted to 928 or 8.7% of all claims. Of these, women accounted for 96.8%, men only reported 30, repeat 30, claims.

We also see a cycle to these claims. They peak in certain months and dip in others, but I will not reveal details. An astute HR person would note these cycles for his organization and can almost predict who will be sick, and when.  

Illnesses last 10½ to 11½ days, and the nation lost 110,164 days of production in 2008, up 19.5% from 2007 (only the 2004/2003 interlude was higher at 20.1%). 

Are some of these sicknesses avoidable? Consider this: for 2008, there were 20 cases of alcoholic intoxication, 9 animal bites and 144 lacerations/wounds. And, if the Health professionals are to be believed, that diabetes and hypertension - the so-called lifestyle diseases - can be managed and controlled, then the 513 cases claimed for them may be minimized. Further, with better hygienic practices, 180 gastro-enteritis cases could be diminished. With better posture, better ergonomics, the 643 back pains/strains could be lessened. Indeed, one of the suggestions received during reform discussions is for Social Security to conduct work site safety inspections with a view to refusal of claims to the Employment Injury Branch for injuries caused by work place negligence or unsafe practices.

As a reminder, sickness benefit is paid to a working insured person, between age 16 and 62 years old, who has paid a minimum of 26 contributions, has been at work for 8 of the last 13 weeks and must have been in immediate employment when the illness took place.  Sickness claim is paid after 3 continuous days of illness and for a maximum of 26 weeks.  The employer is under no legal obligation to pay any part of salary while an employee is sick, but may elect to do so.

It should be clear that the current system is untenable, and as that debate intensifies, so too does the urgency for the nation to provide Universal Health Care. What do you think? E-mail us at ssb.reform@socialsecurity.kn with your comments.

One ounce of prevention versus millions of dollars for cure!