The World Bank classifies the Dominican Republic (DR) as an upper-middle income economy with a $5,770 gross national income per capita (WB, 2015). The country is one of the top performers in terms of economic growth in Latin America. Paradoxically, after analyzing main social indicators one wonders why this economic development has not been translated into notable social progress over the years. In this blog I will focus on public health.
Aiming towards universal health coverage would contribute to reducing the incidence of catastrophic health expenditure. High health costs often have severe consequences in increasing poverty headcounts. In the DR there are important obstacles that prevent the country from reaching universal health coverage, such as very low government health expenditures and a big informal sector. Public health expenditure was 2.4% of GDP (WB, 2015) on average during 2000-2012, one of the lowest in Latin America.
Despite some achievements in health outcomes over the last decade, basic public health indicators such as infant mortality rate remain way above the Latin American average and worse than countries with similar levels of economic development like Costa Rica. In 2013, it stood at 23.6 per 1,000 live births, as compared to 8.4 per 1,000 live births in Costa Rica (WB, 2015).
Meeting the goals of the 2001 health reform and achieving universal health coverage is not an impossible task. For example, Thailand has had a universal health coverage scheme since 2002, when it had similar levels of public health spending as DR has today. It is a matter of designing the correct payment incentives based on performance indicators to improve quality in the system. Also, reforms should be piloted focusing on the most vulnerable populations that are affiliated to the national health insurance, SENASA. Currently, 29% of the population is affiliated through the subsidized regime (SISALRIL, 2015), but its expansion has been low given that it relies directly on budgetary appropriations. There is a significant opportunity for improvement if the mixed subsidized-contributive regime is fully developed, which allows for more poor people to be targeted into the subsidized regime.
The Dominican Republic is an amazing country with very favorable economic prospects. It is time to revisit the organization of the public health system and contribute to build a bridge between the status of upper-middle income country and its social indicators.