1. SINT MAARTEN COUNTRY REPORT Component one Findings and proposals Dana Kweekel, HBN Law Sint Maarten

2. Sint Maarten www.hbnlaw.com Country within the Dutch Kingdom High degree of international autonomy Overseas country and Territory (OCT) Denouncing conventions Civil law country; monistic view on international law

3. Target group: all migrants: - documented and undocumented; - employed and unemployed; - family members and children.

4. International law www.hbnlaw.com Universal Declaration on human rights International Covenant on economic, social and cultural rights Convention on the rights of the child Convention on the elimination of all forms of discrimination against women European social charter European Convention on human rights

5. Sint Maarten’s obligation to provide HIV/AIDS medical care and treatment under international law www.hbnlaw.com Sint Maarten’s is – based upon various sources of international law – obliged to provide medical treatment and care to its citizens; However: as these obligations are not considered to be self- executing-treaty provisions, citizens cannot invoke these provisions in court.

6. Sint Maarten’s obligation to provide HIV/AIDS medical care and treatment under national law www.hbnlaw.com The Constitution of Sint Maarten does not contain a specific human right to health and medical care. It does, however, contain an elaborate an not restricted right to equality, which forbids discrimination on any ground, therefore including legal status. If national legislation is judged to be in violation with this ban on discrimination, then the Sint Maarten courts are forced to set aside this national legislation.

7. Regulatory framework www.hbnlaw.com In Sint Maarten, the following regulated insurances exist: 1.National Health Insurance Ordinance; 2.National Ordinance regarding the compensation of treatment and care costs for government personnel; 3.Sint Maarten Medical Assistance Ordinance; 4.Exceptional Medical Expenses Ordinance; 5.National Ordinance on Accident Insurance; 6.60+ Insurance. Initial steps are taken to change to a compulsory basic health insurance. All those who do are not insured under any of the aforementioned regulated insurances have to rely on (expensive) private insurances.

8. Who is not (completely) insured under the regulated insurance types? - 1 www.hbnlaw.com children: 1.undocumented children of an employee's family member (partner): no rights 2.children and family members of public servants: 90% compensation; 3.undocumented children of former employees: no rights; 4.undocumented children of unemployed migrants: no rights. family members: 1. undocumented family members of employed documented / undocumented migrants: no rights; 2.family members of public servants: 90% compensation;

9. Who is not (completely) insured under the regulated insurance types? - 2 www.hbnlaw.com public servants with a high income: 90% compensation unemployed undocumented migrants (of age): most unemployed undocumented migrants who will not be able to afford a private insurance and are therefore not entitled to any kind of HIV/AIDS treatment and care.

10. Not covered under private insurances: www.hbnlaw.com A person who has been diagnosed with HIV/AIDS prior to applying for a private insurance will not be accepted and will: as a consequence he/she will have no right to compensation for HiV/AIDS medical treatment and care. If the diagnosis is set after the application has been granted: there will most likely be a limited coverage.

11. National Health Insurance System www.hbnlaw.com Transit to NHI Insurance compulsory Basic package with additional insurance possibilities Guarantee fund Based on income tax

12. Costs and Sustainability www.hbnlaw.com European Patent Convention Supplementary Protection Certificates Reducing prices by pharmaceutical companies

13. Proposed interventions www.hbnlaw.com 1.Children are vulnerable and are subject to special attention and protection. It can be argued that the distinction made in the National Health Insurance Ordinance between documented and undocumented children is in violation with the right of equality as described in the Constitution. This distinction could be amended by changing the definitions of the Ordinance. 2.The Sint Maarten Medical Assistance Ordinance could be changed in such a way that the requirement of residency is cancelled. 3.The scope of the Exceptional Medical Expenses Ordinance could be broadened via a Decree stating that HIV/AIDS treatment and care is considered to be a chronic illness and that the incurred costs can be charged to it.

14. Proposed intervention www.hbnlaw.com 4.In order to reduce the costs related to medication (in general), a Decree could be issued introducing maximum prices for medicinal products as was done by the Curacao government recently. 5.Government support in negotiations with pharmaceutical companies about price-reductions could increase the chances of success. 6.Government could introduce or support a guarantee fund to cover the costs for HIV/AIDS treatment and care insofar as these are not covered by any other insurance. This fund could be open to co-funding by private organizations, which would reduce the additional burden on the Sint Maarten budget.