Dominican Republic : Implementing a Health Protection System that Leaves No One Behind

Rathe, Magdalena

World Bank, Washington, DC

关键词: UNIVERSAL HEALTH COVERAGE;    HEALTH FINANCE;    HEALTH SYSTEM REFORM;    BENEFITS PACKAGE;    SUBSIDIES;   

RP-ID  :  122808

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

During the last 50 years, the DominicanRepublic has experienced important economic growth, withrates higher than most Latin American countries. However,despite the substantial reduction in poverty and indigencein recent years, average wages within the formal sectorremain extremely low, and a large proportion of theworking-age population is outside the formal sector. Thecountry introduced a structural health reform in 2001, whichhas been successful in affiliating 70 percent of thepopulation to the Family Health Insurance, with a completepackage of services with the same content for all, althoughwith different forms of financing and provision of services.However, the public service network, which is legally incharge of providing care to the lower-income population,lagged in its restructuring process, with serious problemsof quality, efficiency, and governance. Thus, although manyof the coverage goals have been achieved, population healthoutcome indicators remain well behind most countries in theLatin America region. Another key aspect of the pendingagenda to achieve greater health and financial protectionwithin social insurance is the in-depth revision of theBasic Health Plan (Plan Básico de Salud). This revision’sobjective would be built on guaranteed coverage of certainhealth conditions considered to be priorities, including therestructuring of the health care model to introducerationality, control costs, reduce or eliminate fundingdifferences between the Contributory Regime (RegimenContributivo) and Subsidized Regime (Régimen Subsidiado),and increase public funding for the Subsidized Regime. It isnecessary to ensure that the benefits provided in the BasicHealth Plan are delivered; that is, that the servicesrequired by the population are effectively covered, whichwill also reduce out-of-pocket spending. It is necessary tomonitor the financial situation of all entities of thehealth system and to continue strengthening institutionalcapacity to carry out the financial and technical audits ofhealth providers. The permanent monitoring of the financialsustainability of the Family Health Insurance SubsidizedRegime and the Basic Health Plan is fundamental, while asystematic analysis of the fiscal space is carried out.