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Puerto Rico healthcare: Doing more with less
Published Thursday, October 11, 2018
by María Soledad Dávila Calero

Por Caribbean Business

Editor’s note: The following originally appeared in the Oct. 11-17, 2018, issue of Caribbean Business.

Budget cuts imposed by the Financial Oversight & Management Board have been particularly challenging for a Puerto Rico healthcare sector that is already wrestling with rationing of services tracing to federal funding for Puerto Rico that is 43 percent below the national average.

With a budget cut on one hand and healthcare needs on the other, the Puerto Rico Health Insurance Administration (ASES by its Spanish acronym) is trying to provide efficient healthcare coverage for both government employees and people utilizing the government-sponsored program, but a lack of healthcare-funding parity with U.S. states limits the amount of progress, say industry experts.

During a Puerto Rico Chamber of Commerce healthcare forum, “De Obamacare a Trumpcare,”Ángela Ávila, ASES executive director, focused on the outlook for healthcare coverage that the government provides to its employees, and argued for the need to eliminate division within public-sector employees to get “better risk distribution and a better price” for the healthcare plan.

Aside from the local government, Puerto Rico’s healthcare system is funded through federal allocations, where the island falls behind all states and the U.S. Virgin Islands. Roberto Pando, president of MCS Advantage, a leading health insurance provider in Puerto Rico, argues that ultimately, Puerto Rico’s healthcare infrastructure cannot work at an optimal level.

Integration strategy

For Ávila, separating public-sector employees covered under Act 95 of 1963, which provides healthcare coverage for most employees in executive branch agencies, and those who are exempt, such as the employees in public corporations, has led to large disparities between sectors of government employees. Transitioning to a system with a smaller budget may include bringing public corporation employees under Act 95, which falls under ASES.

Establishing the path forward, the ASES executive director explained, has been a combined move with the Fiscal Agency & Financial Advisory Authority (Fafaa, or Aafaf by its Spanish acronym), but argued that the considerations in this discussion are not just financial.

“There is room for discussion with the fiscal board, but the important thing is to bring a reasonable argument. When we are talking to the fiscal board about this initiative, [it is in] the spirit of making a pondered contribution. Between the central government and the public corporation, there is great disparity, so the intention is to make