Healthcare in Puerto Rico before Hurricane Maria and after


Hurricane Maria came at a worse time for Puerto Rico. The island was deep in debt, filing for bankruptcy, and the healthcare system was almost facing stagnation. The worrying relationship in Puerto Rico and Medicare, the public healthcare system, the dwindling economy, Medicaid, and the declining or aging population have described the efficacy and extent of the healthcare system. Thesis: from the monumental challenges faced by Puerto Rico as a result of Hurricane Maria, it is about time the island experienced a significant change in healthcare.

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About the island

The island is a United States territory since 1917 that has its healthcare system in the United States federal control but with little rights and privilege of the full state control (Dietz, 2018).

Puerto Rico has had cases of bankruptcy and debt, which as particularly high in 2017 when the debt crisis hit hard on the government: the next major financial crisis for the island after the great depression (Dietz, 2018).

The island was hit by Hurricane Maria in September 2017, causing significant damage (Kishore et al., 2018).

Healthcare System

Doctors and health professionals have employment from the Puerto Rico government, and all the 78 municipalities within the island had publicly funded clinics, Care Centers, or hospitals (Morse et al., 2011).

Puerto Rico enacted La Reforma in 1993 to sanction public to private shift by the physicians, prompting the government to sell the public healthcare centers to the private organization (Morse et al., 2011).

The island‘s economy is majorly on health accounting for 20% of the economy. Healthcare is unstable (Roman, 2015).

Medicare and Medicaid in the United States reimburse Puerto Rico state 50% of the healthcare expenses despite being the poorest of all states, which are below half of the total health care expenses in Puerto Rico (Roman, 2015).

Puerto Rico residents depend majorly on public health, and most of them are insured by about 94% (Unit, 2010).

Factors Affecting the Health System

The population of the island is aging and has high rates of poverty in addition to the high rates of chronic conditions (Perreira et al., 2017).

The economy has been on the economic decline. To pay for the public services cost of publicly funded healthcare services included, the island borrowed money issuing municipal bonds (Perreira et al., 2017).


The significant challenges are the structural, payment environment, and quality care (Perreira et al., 2017)

Future Health Projection

The island is having an increase in suicide deaths at 18%, and the mental disorders and mortality rise. This illustrates that the island is becoming sicker, with the economy having significant challenges than before (Hardy et al., 2019).

Puerto Rico has a slow recovery; an example from the Ryder Memorial Hospital; however, the slow recovery leaves the island exposed to further external attacks on healthcare (Hardy et al., 2019).

The impact of the hurricane exposes the island to further exodus of the population out of the island (Hardy et al., 2019).

The congress passed the bill on 100% Medicare or Medicaid for the Puerto Ricans in September 2019; however, the change comes with the cry of a permanent solution and more powerful disaster preparation (Hardy et al., 2019).

Comparison to the United States Health System

Compared to the U.S. system, the health system is a relatively small private sector economy. It has both the private sector and the gross national products are shrinking due to the shrinking tax base (Perreira et al., 2017).


Dietz, J. L. (2018). Economic history of Puerto Rico: institutional change and capitalist development. Princeton University Press.

Hardy, M. C., Stinnett, R. C., Kines, K. J., Rivera-Nazario, D. M., Lowe, D. E., Mercante, A. M., … & Toro, M. (2019). Lessons from the reestablishment of Public Health Laboratory activities in Puerto Rico after Hurricane Maria. Nature communications10(1), 1-8.

Kishore, N., Marqués, D., Mahmud, A., Kiang, M. V., Rodriguez, I., Fuller, A., … & Maas, L. (2018). Mortality in Puerto Rico after hurricane maria. New England journal of medicine379(2), 162-170.

Mattei, J., Tamez, M., Ríos-Bedoya, C. F., Xiao, R. S., Tucker, K. L., & Rodríguez-Orengo, J. F. (2018). Health conditions and lifestyle risk factors of adults living in Puerto Rico: a cross-sectional study. BMC public health18(1), 491.

Morse, D. E., Vega, C. M. V., Psoter, W. J., Vélez, H., Buxó, C. J., Baek, L. S., … & Ayendez, M. S. (2011). Perspectives of San Juan healthcare practitioners on the detection deficit in oral premalignant and early cancers in Puerto Rico: a qualitative research study. BMC Public Health11(1), 391.

Perreira, K., Peters, R., Lallemand, N., & Zuckerman, S. (2017). Puerto Rico Healthcare Infrastructure Assessment. Health Policy Center.

Roman, J. (2015). The Puerto Rico healthcare crisis. Annals of the American Thoracic Society12(12), 1760-1763.Unit, E. I. (2010). Puerto Rico. Quarterly Economic Reviews.

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