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by HECTOR BERRIOS FIGUEROA
August 17, 2000
There were many who said that the implementation costs of the health reform would sink the government into a financial crisis so as to even cause a reduction of healthcare services in Puerto Rico. Yet the development and results to date have proven otherwise.
Health reform was enacted with six basic and sometimes overlapping goals; to eliminate public and private sector disparity and discrimination in healthcare, guarantee access to quality care to all residents, allow free choice for healthcare providers, improve quality of service, increase efficiency and productivity in the healthcare industry through competition, and limit the role of government in the areas of health promotion and disease prevention.
In an exclusive interview with CARIBBEAN BUSINESS, Health Department Secretary Carmen Feliciano spoke about the achievements of the most important and controversial health program in the islands history and the problems its implementation has encountered.
According to Feliciano, the arrival of the health reform in San Juan was the most difficult step of the implementation process. San Juan, with an estimated 130,000 medically indigent residents, was the last of the 78 municipalities to implement the health reform. "It wasnt easy at all, but it was expected to be that way," said Feliciano.
Under the health reform conceived by Gov. Pedro Rossello, the central government has sold its state-owned health facilities to private operators, in turn buying private health insurance for the islands indigent population. The success of this program has been possible because of the collaborative efforts at the municipal, regional, and central government levels.
Feliciano said the reform has meant better access to care for the medically indigent. Those covered by health reform are allowed to choose their own healthcare provider.
"If you take a look at the results, youll find that before the reform there were at least 80,000 people who were certified under Medicaid in San Juan. Today there are more than 120,000 certified under the health reform," she added. Most current estimates expect that number to grow to 145,000 by December. (See related story page 31.)
A survey conducted by the Health Department before the implementation of the reform in the capital revealed that 80% of the population of San Juan wanted the reform. "The Department identified over 30,000 users of the reform in the first eight weeks, which was not easy either," said Feliciano.
Expanded coverage of health services is one of the most significant accomplishments of the health reform. It includes ambulatory services, surgical, hospitalization, maternity, mental health, prescription drug services, dental, emergency room, rehabilitation, drug addiction treatment, ground and air ambulance, laboratory testing, and catastrophic coverage (including AIDS, TB, cardiovascular, cancer, neonatal, intensive care, and others).
According to a July survey conducted by the Department and the Health Insurance Administration (ASES, by its Spanish acronym) 90% of health reform users are satisfied with the services provided.
Among other Departments achievements, Feliciano mentioned that no Aids cases in children have been reported this year and there has been a reduction in adult and infant mortality rates. In a recent report on Aids cases, Puerto Rico dropped from No. 3 to No. of 5 in the nation in number of cases per 100,000 last year.
Vaccination is another area were success has been achieved. "In 1990, 12 children died of measles in Puerto Rico and we had half of all measles cases in the U.S. When I was appointed Secretary, the vaccination rate was at 38%, but in the last three years, Puerto Rico has been ranked No.1 in vaccination in the whole nation," she said.
"Before the reform, dental care services were only offered to Head Start children and pregnant women. Now that has changed. The population lacked that service and we knew that the reform would increase the demand," said Feliciano.
Besides that, the Government Development Bank recently reported that health reform has helped the Health Department save $235 million in operational costs, a sum that, according to Feliciano, is still increasing and will continue to grow. "The reform has also made it possible to stop the increase of healthcare costs," she stated.
Status of health care facilities
A recent controversy of the health reform has been the sale of public hospitals and Diagnostic and Treatment Centers (CDTs) to the private sector. The first step of the privatization process was the lease of the public health facilities located in the areas where the reform had been implemented. A dozen facilities, both hospitals and CDTs are operating under leasing contracts at present.
The second step of the privatization process was the sale of public health facilities. To accomplish this, the government had to amend or adopt legislation, which expedites and facilitates the sale of the state-owned CDTs and hospitals. These facilities are now sold to private profit and non-profit organizations.
"If the facility has no buyer, the government will continue to provide medical care," Feliciano explained.
The Health Department is currently administering the Bayamon and Mayaguez hospitals, but negotiations for sale are advancing and contracts will be signed soon. The Centro Medico hospitals in San Juan (University Hospital, Pediatric Hospital and the Puerto Rico Cardiovascular Center) are also administered by the Department and there are no plans for sale of these facilities.
More and new challenges
"Complaints come from healthcare providers, mostly the laboratories, pharmacies and doctors. They complain because they get late payments, but it also happens with private insurers. Healthcare providers will never be satisfied with what they receive," she continued.
She said as a pediatrician in the private practice 10 years ago, clients came to her for counseling before joining any of the available health plans. Although she recognized that some plans were not as good as others, she explained the offerings and benefits of each plan in detail and let then the client decide which to go with.
The Health Department is pondering if the island should remain divided into regions covered by individual healthcare providers or if it should be considered as a whole with all providers offering services at the same time.
"The reform is complex and I believe that the best option is to consider Puerto Rico as a whole and let providers compete and let the people choose," said the Secretary.
Now that health reform has been implemented in all municipalities, the Health Department faces other challenges. The biggest of which is to focus on prevention and promote healthy habits.
"It is essential that we educate the population and help them understand that it is important to exercise, eat healthy foods, that smoking is not a healthy practice, and help them adopt a healthier lifestyle or abandon unhealthy activities," she said.
To accomplish that, the Department has developed various programs and alliances to involve the public officials as well as the community in an educational campaign to promote a healthy living.
Carmen Feliciano feels proud and satisfied with her job. She said her greatest joy is when people come to express their gratitude for the governments efforts on behalf of the publics health.
This Caribbean Business article appears courtesy of Casiano Communications.