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Dominican Republic Healthcare


The Secretariat for Public Health and Social Welfare is the agency in charge of health services and is structured on central, regional, and provincial levels. Eight regional offices direct the services and oversee the health units at the provincial level. According to data from the Secretariat for Public Health, in 1996 there were a total of 1,334 health facilities in the country, of which 730 (55%) came directly under the Secretariat, 184 (14%) under IDSS (the Dominican Social Service Institute), 417 (31%) under the private sector, and 3 (0.2%) under the armed forces.

There were 15,236 hospital beds of which:

• 7,234 (47%) belonged to the Secretariat;
• 1,706 (11%) to IDSS;
• 5,796 (38%) to the private sector; and
• 500 (3%) to the armed forces.

These numbers represent a bed/population ratio of 1:500.

IDSS is an autonomous institution, which operates a social insurance programme for which all employed persons, and wage earners in state- owned corporations are eligible. However, workers earning more than DOP 4,004 ($249) per month are excluded, as are domestic workers and family businesses. The system provides cash sickness and medical benefits. The employer pays an average of 7.5% of payroll, the employee an average of 2.5% and the Government 2.5% (based on maximum earnings as indicated above); these contributions also fund old age and disability pensions.

In 1994, 6.5% of the general population and 15.4% of the economically active population were affiliated with IDSS, and its expenditures represented 0.7% of the GDP.

Healthcare provision in the country is considered poor, with an estimated 1 doctor to every 1,000 inhabitants. A 1997 United Nations report indicated that 22% of the population received no healthcare. The poor level of state healthcare available is evidenced by the growing demand for private healthcare cover, which is invariably provided by employers.

Private Healthcare

Private medical contracts are a form of health insurance developed by private medical centres to expand their client base and guarantee a steady flow of income. Through this system the clinics in the major cities have been able to attract large numbers of workers whose income levels would not otherwise allow them direct access to the services. The range of services varies depending on the specific plan but usually includes medical care and out-patient maternity care, and hospitalisation in some cases. Prescription drugs are only covered during hospitalisation. Some non-profit private services are provided by clinics and hospitals managed by non-governmental organisations. For example, some institutions or foundations offer low-cost services for such specialised problems as diabetes, cardiovascular diseases, skin diseases, cancer, or rehabilitation.

A number of these institutions receive sizeable government subsidies through the Secretariat for Public Health, and they also may be paid directly by users. Private for-profit services have been growing rapidly in recent decades. They are provided in facilities ranging from highly sophisticated private hospitals to small centres operating under uncertain conditions, usually located in outlying urban or semi-rural areas.

Group Private Medical Schemes

Employee benefit packages frequently provide group medical insurance coverage, which usually extends to cover all employees not eligible for social security benefits, and will sometimes include employees eligible for such benefits. Bills will usually be settled directly by the insurer. Coverage varies from one insurer to another but is mostly based on US-style comprehensive basic and major medical plans, which typically will include the following coverage's:

• hospitalisation – room and board (daily benefit);
• hospital services – nursing, blood, plasma, medication, dressings etc;
• surgery and anaesthetics (usually excluding dental surgery);
• doctors' visits - in hospital and post-surgery out of hospital;
• specialist consultations;
• laboratory tests and x-rays;
• ambulance services;
• maternity benefits;
• out-patient charges including x-rays, drugs obtainable from pharmacists, artificial limbs, splints, and casts.

An annual deductible in the region of the equivalent of $100-200 typically applies, and reimbursement of costs in excess of the deductible is usually limited to 80%. However sometimes a cap is placed whereby, for example, should costs exceed $1,500 the insured is fully reimbursed for the excess.

Coverage usually extends to the employee's spouse and children. A typical limit would be DOP 60,000 ($3,727) per event and an annual limit of DOP 240,000 ($14,907) per family. This would be for coverage restricted to the Dominican Republic, and policies are also available providing worldwide coverage.





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