The Role of Community Healthcare Centers in Puerto Rico

Interaction with Medicare, Medicaid, Commercial and the Economic Impact to the Island

Víctor M. Ramos-Otero, MD President

Puerto Rico College of Physicians and Surgeons

330 Health Centers

330 Health Centers

• Unlike the Puerto Rico Government and the Health Insurances, the 330 Health Centers in Puerto Rico are the only organizations that have credibility when comes to federal funds, and this is because they are administrated by a Community Board that guarantees the proper use of their funds.

• The Puerto Rico Government has insisted in resist this kind of health

model, even failing to pay what they owe to these centers, putting at risk the services they render to our community.

330 Health Centers

• As contradictory as it can be, the government has a Negotiator Committee in the Federal Department of Health where there are no health providers as part of its team, nor the Secretary of the Health Department. Moreover, this committee has persons that were expelled from the CDT of Culebra to the 330 Health Center of Culebra.

• The 330 Health Centers provides high quality integrated services for

primary care, and I’m confident that my fellow panelists who work every day in these Centers will elaborate on this.

Puerto Rico Health Care System

Puerto Rico Health Care System • Puerto Rico’s Health Care System is designed for and by the industry of

health insurance with a State Plan that only benefits them. This health care model has to change.

• Through the Multisector Committee created by the Law no. 235-2015, a cost-effective health care plan model has to be designed. This health care plan model has to beneficiate the patients, and has to be fair with the service providers. A universal health care single payer should not be discarded as an alternative.

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Puerto Rico Health Care System • A State Plan that includes a Medicaid Fee Schedule should be created in

order to have access to health care plan models that does not requires full control from the health insurance industry.

• The failed Administration of Health Insurances of Puerto Rico (ASES) should be eliminated, and give back its functions to the Health Department. 20 years ago we were told that physicians were not able to manage our health care system. All these years other non-physicians professionals have played the role of administrator of ASES, this clearly have been proved to be a failure.

Puerto Rico Health Care System •  In order to change the current health care system, the Medicaid

Management Information System (MMIS) is needed as soon as possible. We cannot wait 4 years to make it happen.

• A Fiscal Control Board has to be created, and it should be composed by service providers and patients to ensure proper use of funds. The members of this Board should be people who knows first hand the current situation of Puerto Rico and not in the abstract as foreign persons would.

Puerto Rico Health Care System • We should work for real parity in ALL health care programs of Puerto

Rico, not only those that the health insurances administer. In fact, the role of the health insurance industry must be limited to the minimum in the public health care system.

• The Health Services Cooperatives must be promoted as an effective mechanism to deal with the health care system issues, like Brazil and Germany have done.

Puerto Rico Health Care System •  In order for the government to manage the health statistics in Puerto Rico

instead of the private insurances, the Puerto Rico Health Information Network (PRHIN) should be put in function.

• Considering the failure of MMAPA and the Health Crisis Coalition in trying to achieve parity for Puerto Rico, instead they award themselves the accomplishments of the Resident Commissioner of Puerto Rico, the Federal Affairs Office in Washington, the P. R. College of Physicians and Surgeons, Hospital Association, and the Coalition of Health Service Providers. In this regard, the parity efforts should be delegated on the Secretary of the Health Department, the health services providers, and the patients. We have what the government and the health insurance industry don’t have, credibility.

Puerto Rico Health Care System

Last, but no least We invite all of you to the most important event of this day, not this forum, but the orientation meeting of the Multisector Committee to be held this afternoon at 6:30 p.m., at the Law Faculty of the Inter American University in Hato Rey.

Fight for parity,

Fight for what is fair.

Lets transform our health care system, NOW!

Víctor M. Ramos-Otero, MD President

Puerto Rico College of Physicians and Surgeons

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