IN REACH

Dominican Republic 2019 | HEALTH | REVIEW

With over 10 million citizens to serve in a country whose per capita GDP is just over USD7,000, the Dominican Republic's healthcare system is relatively affordable. Although there are complaints about the quality of service in public hospitals, the country is ahead of the curve in the region, at least in terms of providing its citizenry with free medical treatment.

Until the turn of the millennium, the Dominican Republic was plagued by the poor quality of healthcare facilities, a lack of accountability on the part of healthcare providers, and high out-of-pocket payments by patients. In 2001, however, a reformative law was approved by Congress that paved the way for the birth of the republic's modern health system. Some byproducts of that reform include the Family Health Insurance (SFS) and the contemporary Health Services Plan (PDSS).
Although SFS was not a quick fix that put an end to all of the system's ailments, it expanded the public's access to basic healthcare services considerably. According to the World Bank, SFS' coverage has skyrocketed from around 65,000 in 2004 to just under 7 million in 2016.

At present, the healthcare sector is mainly formed of 12 major public hospitals, seven independently run public hospitals, and over 1,700 primary care facilities that can be found in every major town. There are also a number of well-equipped private hospitals based in Santo Domingo and Santiago, which are sophisticated enough to carry out complex operations inside the country—often performed by doctors and healthcare professionals trained in the US.
These private hospitals are the main drivers of the Dominican Republic's medical tourism, which is increasingly attracting patients who are seeking dental care, laser eye treatment, and cosmetic surgeries from elsewhere in the Caribbean.
Medical tourism in the country dates back to the late 1990s, and the Dominican Health Tourism Association (ADTS) took important steps in 2018 to promote the sector by enhancing the quality of medical services for overseas patients and signing agreements with major players in the country's mainstream tourism sector.
Most Dominicans, however, cannot possibly afford private healthcare, while the public hospitals serving the nation leave a great deal to be desired. Public hospitals—for one thing—lack sufficient diagnostic equipment; the penetration rate of MRI scanners in the country's state-run hospitals, for instance, is still under 5%.

What is more, public hospitals are said to charge patients for medical imaging services, wound dressing and stitching, and most medication, which is not in line with the spirit of the country's healthcare reforms. According to a 2010 report by the World Health Organization (WHO), over 40% of Dominican patients end up paying the state hospitals in one way or another.
These shortcomings, however, are beginning to be addressed. A presidential decree was signed in 2017 that will, among other things, ease the debts of many public hospitals, thus enabling them to acquire more equipment and recruit more professionals.
There are also a number of clinics in all major cities that focus on serving the expat communities. Such clinics often have bilingual personnel as well as latest medical technologies and, therefore, charge higher fees than local clinics. Although these clinics are seen as more chic establishments, they are more suitable for taking care of routine healthcare services rather than major preplanned medical procedures.

Indeed, one of the criticisms of the Dominican Republic's health sector is that it is highly fragmented, with the quality of medical services varying from location to location and from one type of clinic or hospital to another, though the gap was to a certain extent offset by the 10-Year Health Plan (PLANDES) between 2006 and 2015.
The Dominican Republic is working hard toward its goal of achieving 100% healthcare coverage across the country by 2030. A report published by the World Bank in 2018 acknowledged that the country is taking right steps in the right direction 17 years after the first reforms in the health system, adding that these steps “could lead to the achievement of true health coverage, on the way to universal coverage."