Our shift from a regionalized public health system into a Medicaid managed care system (“La Reforma”) in 1993 changed the landscape of healthcare in Puerto Rico.
After Hurricane María, this landscape has become a crumbling, barren one. We are facing a public health emergency that only deepens with our aging population, increase of chronic diseases, and high living costs.
We need to stop this hemorrhage before it is too late. Access to quality healthcare should be a top priority.
Puerto Rico’s healthcare system is hemorrhaging. We’re bleeding out physicians, dentists, nurses and other providers. Healthcare professionals are moving to the mainland looking for better paying jobs, training opportunities, and quality of life.
The Department of Health estimates that in the last 12 years, more than 2,400 physicians left the island, mostly to practice in the United States. According to estimates by the College of Physicians and Surgeons of Puerto Rico, two physicians leave the island every day.
In 2016, there were only 9,000 physicians practicing medicine; roughly five physicians per 2,000 inhabitants. The situation isn’t better for other healthcare professionals. Today, we only have 897 active dentists; one dentist for every 4,000 inhabitants. Other providers, such as nurses, are still here in adequate numbers. For a population of 3.5 million, the number of professionals seems insufficient.
Healthcare professionals are aggressively recruited by institutions in the U.S.A., in part due to their bilingualism. Many of my doctor friends and acquaintances are now living stateside. To lessen the migration problems, Act No. 14-2017, the “Incentives Act for the Retention and Return of Medical Professionals” offers tax incentives for medical professionals to stay on the island.
This approach is not enough. This law applies to specialists and surgeons, medical residents, podiatrists, and dentists; general practitioners, nurses and most health professionals are not included.
Furthermore, providers find it hard to stay afloat because of the high cost of living in Puerto Rico. Healthcare providers contracting with health insurance plans are not getting paid in a timely manner. Complaints emphasize health insurance companies often deny authorizations for procedures and/or refuse to pay for submitted claims.
Providers face shortage of resources at hospitals. Health professionals are struggling with decreasing incomes and increasing overheads. Some physicians are paid $2 a month after working 80 hours a week. Hospitals have cut down employee hours and salaries because they are not paid reimbursement in a timely manner.
Patients are migrating too. Lack of quality, timely care drives patients to look for services elsewhere. Distribution of professionals throughout the island is not equal. Patients wait up to one year for medical appointments and wait times at the office can be very long. Services and surgeries are delayed.
We need additional incentives to make it attractive for healthcare professionals to practice in their chosen fields and remain here in Puerto Rico. We need training centers and opportunities for professional growth. We should develop medical tourism, and provide incentives for participation by health centers and hospitals. We should encourage alternative providers including nurse practitioners and physician assistants.
We can provide grants or scholarships to student professionals who commit to stay and practice in Puerto Rico for an agreed-on number of years. Health insurance plans and government insurers must fairly reimburse providers within a reasonable time.
Above all, we need more than a tourniquet to save our healthcare providers and to save our healthcare system.
Author Samira Rosa Colón, MPH, is a graduate student with a Master’s of Science in Clinical Research Administration from The George Washington University.