Quality Control

With the Social Insurance Act 87-01, promulgated in 2001, compulsory health insurance became a reality. The Service Health Plan (PDSS) followed in 2007, and as a consequence, the health of the average citizen of the Dominican Republic has changed for the better. Low-income citizens can receive largely free medical services at branches of the nationwide network of public clinics. Workers that earn less than Ps4,000 per month have the option of choosing a social security system that provides coverage for a range of facilities, but does not cover the families of workers. The other option is the increasingly popular private healthcare system, which allows access to the highest-quality services at a price. For major insurance providers, such as Universal, The Colonial, and Seguros Banreservas, social insurance is an important component of their overall portfolio. For foreign firms interested in establishing an insurance or reinsurance firm, Dominican law outlines a comprehensive structure for investment.

In conversation with TBY, Luis Rojas Grullon, President of Clinica Abreu, noted that “public health surveys reveal that 40% of people use public facilities, while 50% use private. These services are intended to be both sufficient and free and yet we have poor citizens receiving private healthcare.” The quality of some of the private facilities in the country is so high, in fact, that the Dominican Republic is by now well known as a medical tourism destination. Its eight international airports received 4.69 million non-resident visitors in 2013, a number of which were visiting to take advantage of the superb medical services available at a fraction of the cost in the US and Canada. It follows then, that the geographic proximity of the Dominican Republic, its restorative climate, and an efficient and simplified visa process for certain nationalities has boosted segment growth. Areas of specialty and services provided by US and European-trained doctors, along with local experts, include plastic and cosmetic surgery, cardiovascular and weight management procedures, bariatric medicine, hair replacement, and dentistry. The segment is supported by the Dominican Association for Health Tourism.

The quality of the healthcare system is guaranteed by the Colegio Médico Dominicano (CMD), which works to ensure that the profession maintains its credibility and conforms to international legal and ethical norms, fostering solidarity within the community of healthcare providers. The CMD also works alongside government institutions to increase the penetration of information technology in the healthcare sector, and to augment the presence of online services, in tandem with the government’s eDominica initiative. Health and social security services are increasingly available through digital interfaces, with free public services accessible for 75% of the population and regulated by the General Health Law.

The Dominican Republic possesses some of the most productive medical device manufacturing facilities in the region. In 2011, the production of these instruments represented 10.01% of products exported by the country, approximately equaling the export value of metals in that year at $894 million. According to the Observatory of Economic Complexity (OEC), 65.69% of this equipment, or $587 million worth, was exported to the US, followed by the Netherlands with $52.2 million, Canada with $45.1 million, and Japan with $36.4 million. This is an area of growth for Dominican manufacturing, and is also an important consideration for its health sector.

Another area of importance for the Dominican health industry is the manufacture and export of pharmaceuticals. Again in 2011, $53.9 million in packaged medicaments was exported, while special pharmaceuticals accounted for $77.6 million of exports. The incentives offered by the government are attracting major multinational pharmaceutical companies such as GlaxoSmithKline to the country’s free zones.

A HEALTHY FUTURE

Key challenges remain to combat the maternal mortality ratio, which stood at 100 per 100,000 live births in 2012, higher than the regional average of 68, and the above-average under-five mortality rate of 27 per 1,000, which averages at 15 in other countries in the WHO Americas Region. In addition, though the incidence of malaria is remarkably low compared with other nations, emerging ailments such as Chikungunya Fever and established killers such as tuberculosis will need to be combated in a systematic manner to improve overall quality of life. According to Euromonitor’s Dominican Republic in 2030: The Future Demographic report, the national population will have climbed to 12.1 million by 2030, an 18.4% increase on 2012. This demographic change will have obvious consequences for the nation’s healthcare sector; the number of births will remain higher than the number of deaths as life expectancy rises, and a median age of 31.2 years will make it one of the youngest countries in Latin America. If the training of qualified staff improves, and public and private investment continues to parallel population shifts, Dominican health sector should gain a new lease of life over the coming decade, too.