Puerto Rico Health Reform - Current Status

Current Status

The three largest insurance companies operating in Puerto Rico are currently the only ones participating in the Reform. These are Triple-S, Inc. with 40.4% of the Reform beneficiaries, Medical Card Systems (MCS) with 33.5%, and Humana with 26.1%.

The Reform has faced criticism from different sectors because of the increasing costs associated with the system. Under the administration of Gov. Sila Calderón, the government tried to cut back on services and eliminated many participants from the program in an effort to curtail expenditures. However, the program still requires a substantial amount of funds to cover its $1.4 billion annual expenditures (2005). In 2005 alone, only $400 million was generated from participant deductibles and charges for services to cover program expenses, while the remaining $1 billion in expenses was covered by a subsidy provided by the state government. Since medical costs are expected to increase, experts have expressed serious concerns over the future funding of the program.

These criticisms and fallbacks have led the government to implement more stringent controls over the operations of the Reform as well as to diversify the way it provides services to beneficiaries. A pilot project began in 2003 whereby the government contracted the services of one area directly to a medical healthcare provider instead of contracting an insurance company, and the government has stated that this and other programs may be implemented and expanded in the future in order to reduce costs. However, some politicians, including former Gov. Pedro Rosselló, are campaigning to create a universal health care system by expanding the reform program to all citizens that lack a private insurance plan.