Palau: Non-Communicable Disease Off-Island Treatment Referrals 2020-2022

Background: The Republic of Palau is a small island nation with limited healthcare resources and a lack of onsite subspecialty medical care services such as orthopedic surgery, cardiology, and oncology. Palauans receive sub-specialty healthcare during medical missions from other countries or when they are referred off-island to surrounding countries by the Palau Medical Referral Program. The goal of this study is to identify patterns in costs, locations, and types of cases to elucidate potential areas of improvement to the Palauan healthcare system. Methods: This study utilized the 2020-2022 referral data to analyze the frequency of medical conditions that result in off-island referrals and the associated economic burden. Data is presented in a descriptive analysis. Results: We found that oncology and cardiology are the two most common types of medical conditions requiring off-island medical referrals and that Palau is spending over 2 million dollars annually for referrals on subspecialty medical care. Cardiology and oncology are the most frequent cases and have the highest costs. The results of this study provide insight into the current state of medical care in Palau. Discussion/Conclusions: There is a need for a systematic, timely, and economically feasible approach to subspecialty medical sub-care for Palau, especially cardiology and oncology, to reduce the economic burden for Palau. This approach should be linked with appropriate prevention, risk reduction, and early intervention efforts for these non-communicable diseases.