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Healthcare reform in Puerto Rico. Managed care in a unique environment

P A Hulme1, H Rios

  • 1University of Nebraska Medical Center, College of Nursing, Omaha, USA.

The Journal of Nursing Administration
|March 4, 1998
PubMed
Summary

Puerto Rico

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Area of Science:

  • Health economics
  • Public health policy
  • Managed care systems

Background:

  • Puerto Rico's healthcare system faced rising costs.
  • A transition from a public system to managed care was initiated.
  • The goal was to control expenditures for the medically indigent.

Purpose of the Study:

  • To analyze Puerto Rico's shift to a managed-care model.
  • To evaluate the implications for healthcare costs and beneficiary needs.
  • To assess the long-term viability of the new system.

Main Methods:

  • Review of Puerto Rico's healthcare reform initiative.
  • Analysis of the managed-care program structure.
  • Examination of funding transfer from public to private insurers.

Main Results:

  • Healthcare funding for the medically indigent is now managed by private insurers.
  • A capitated payment plan is utilized for a wide range of services.
  • The initiative aims to reduce overall healthcare costs.

Conclusions:

  • Puerto Rico's managed-care program is an innovative cost-reduction strategy.
  • The long-term success in meeting beneficiary healthcare needs remains uncertain.
  • Further evaluation is needed to determine the program's ultimate impact.

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