Dominican Republic Health Care System
Can I get the medical care I need in the Dominican Republic?
The DR has been given very good ratings by the foreign medical practitioners continuing the care of tourists who have suffered major catastrophic events while on holiday.
In the area of surgery, the D.R. is ahead of many of Latin America in laparoscopic laser surgery. A good volume of patients come from the Virgin Islands, the Lesser Antilles and other parts of the Caribbean to take advantage of the good care and lower fees in this country.
Dental services also offer value for money, with very good treatment and reasonable prices, factors which also attract clients from other countries.
The vast majority of your medical needs can be met on the island. Interventions, however, requiring high-tech equipment or a long period of rehabilitation may not be available.
What kinds of medical insurance exist?
If you are one of the workers who earn less than RD$4,000 per month, you will be making Social Security payments, and you will be entitled to the benefits of the government health services.
Many employers provide something called an iguala, which can also be purchased on an individual basis. Monthly payments are made to a certain clinic, which agrees to provide all of the medical services that you need at no additional cost. Certain limitations may apply. For instance, it may be possible that a certain type of specialist is not available at your particular clinic and you have to go elsewhere, you will in effect have no cover under the scheme.
True medical insurance plans come in various types. One type will reimburse you for your medical expenses, possibly including your medications. This type of plan provides a broad coverage, but you need to have the cash to pay your bills at the time services are provided.
A second type of insurance pays a certain portion of each bill. For example, you might be responsible for RD$50-RD$100 of any doctor’s fee of RD$600. This type of plan often has a restricted list of physicians or clinics, and the list will change from time to time.
Foreign insurance companies based here (primarily from the US) offer insurance which includes coverage abroad. The best idea is to purchase a policy with a very high deductible (excess) for overseas care to reduce the cost, as this is essentially only for major disasters.
Many medical insurance policies are available to individuals for virtually the same price as they are offered through employers. An individual, however, might have to pay for a year in advance rather than benefiting from a monthly payment schedule.
What kind of medical services exist in the D.R.?
There are three different medical systems within this country. The first is a socialized system, mainly for the indigent and extremely poor of the country. In theory, the government provides free medical care to anyone who walks into the appropriate medical facilities. In practice, the patient may need to purchase many of the medical supplies and pay a minimum fee for services.
The second is the Social Security system, for those workers who earn less than RD$4,000 per month. Social Security only provides coverage for the workers themselves and maternity services for spouses; children are not covered.
The third consists of private clinics, which are in reality hospitals, providing fee-for-service care. A new Social Security Law fuses these three types of services into one single system in which socialized-type medical care is to be provided, but this is still in the starting stage.
How good are the different systems?
The free care which the government provides is far from adequate, although it does meet some needs, such as the provision of vaccinations and infant rehydration supplies. Facilities, trained personnel, and medicines are many times lacking. (Since most medicines are imported, they are too expensive to provide for free in large quantities). Patients may be asked to pay for materials and for their prescriptions, putting the costs beyond their financial possibilities. The government sells low cost generic brand pharmaceuticals at its Promese Boticas Populares, but the government is not known to keep the needed inventory levels of these lower cost medicines.
The Social Security system is also far from adequate. Nevertheless, certain Social Security clinics offer good services, and even those people who have alternative medical insurance may choose to take advantage of benefits such as the provision of free milk.
Private clinics as the most well-equipped and well-staffed, both by qualified doctors and nursing personnel. Fees, however, range from RD$400 to RD$3000 for a first visit, depending on the clinic and the specialist. It is calculated that less than 10% of the Dominican population could afford private medical services if it were not for the medical insurance programs.