Q. Historia del desarrollo del sistema de salud en Puerto Rico
No contamos con un libro que describa el desarrollo histórico del sistema de salud de Puerto Rico durante los últimos 20 años. No obstante, incluyo a continución los enlaces o los anejos de informes y otros documentos que pueden servirte para explorar los desarrollos más recientes desde que se privatizaron los servicios con la Reforma de Salud que se implantó en el 1993 y sus varias modificaciones.
Análisis del sector salud Puerto Rico (2004) - Ver Capítulo 3 - Estructura Organizacional y Políticas del Sector Salud
https://estadisticas.pr/files/BibliotecaVirtual/estadisticas/biblioteca/DS/DS_Analisis_Sectorial_de_PR_Final.pdf
Perfil de los sistemas de salud - Puerto Rico (2007) - Ver sección 3. Monitoreo de los procesos de cambio / reforma
https://www.paho.org/hq/dmdocuments/2010/Perfil_Sistema_Salud-Puerto_Rico_2007.pdf
Managed Lives: Privatizing Public Healthin Puerto Rico (2007) - Disertación doctoral - Ver capítulo 1 "Reformando la Reforma" (Documento en anejo)
Economic development plan for the health sector (2014) - Ver páginas 11-30 (Documento en anejo)
Basta ya de pachos: Primer informe del Consejo Multisectorial del sistema de salud de Puerto Ricio (2016) - Ver sección Cronología de eventos en el sector salud: Estados Unidos y Puerto Rico (Documento en anejo)
Understanding Puerto Rico’s Health Care Crisis (2017)
https://centropr.hunter.cuny.edu/events-news/puerto-rico-news/health-care/understanding-puerto-rico%E2%80%99s-health-care-crisis
Understanding Puerto Rico’s Health Care Crisis | Centro de Estudios Puertorriqueños
Puerto Rico has gone through the largest migration to the U.S. mainland since the 1950s. A large portion of this population is composed of young adults and physicians.
centropr.hunter.cuny.edu
También, se han publicado artículos sobre aspectos específicos de nuestro sistema de salud y su impacto en la salud de la población. Los mismos podrían servirte para formarte un panorama más claro y actualizado de los cambios más recientes. Si deseas saber las revistas citadas adelante se encuentran en formato digital en nuestras bases de datos:
1. Conéctate a la página de la biblioteca https://www.upr.edu/biblioteca-rcm/
2. Pulsa la pestaña Bases de Datos
3. Pulsa en EBSCO Journals Fulltext Finder
4. Escribe el título de la revista (ej., Milbank Quarterly) y pulsa el botón de Search.
5. Si aparece el título de la revista que interesas, verifica la disponibilidad de texto completo en las bases de datos a las que estamos suscritos.
6. De estar disponible el texto completo, verifica si el año, volumen y número de la revista que interesas está accesible y procede a buscar el artículo en PDF.
7. Recuerda que, a muchas de las suscripciones electrónicas de revista, les aplica un periodo de embargo o restricción de acceso a los números más recientes.
8. De no aparecer el título de revista que interesas en EBSCO Journals Fulltext Finder, puedes volver a escribir a Referencia Virtual para que un bibliotecario verifique si la suscripción está en formato impreso.
Mucho éxito.
1. Milbank Q. 2015 Sep;93(3):584-608. doi: 10.1111/1468-0009.12138.
On the Outskirts of National Health Reform: A Comparative Assessment of Health Insurance and Access to Care in Puerto Rico and the United States.
Portela M(1)(2), Sommers BD(1).
Author information: (1)Harvard T.H. Chan School of Public Health. (2)Health Resources and Services Administration.
POLICY POINTS: Puerto Rico is the United States' largest territory, home to nearly 4 million American citizens, yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA). We analyzed national survey data from 2011 to 2012 and found that despite its far poorer population, Puerto Rico outperforms the mainland United States on several measures of health care coverage and access to care. While the ACA significantly increases federal resources in Puerto Rico, ongoing federal restrictions on Medicaid funding and premium tax credits in Puerto Rico pose substantial health policy challenges in the territory. CONTEXT: Puerto Rico is the United States' largest territory, home to nearly 4 million American citizens. Yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA). This article presents an overview of Puerto Rico's health care system and a comparative analysis of coverage and access to care in Puerto Rico and the mainland United States. METHODS: We analyzed 2011-2012 data from the Behavioral Risk Factor Surveillance System, and 2012 data from the American Community Survey and its counterpart, the Puerto Rico Community Survey. Among adults 18 and older, we examined health insurance coverage; access measures, such as having a usual source of care and cost-related delays in care; self-reported health; and the receipt of recommended preventive services, such as cancer screening and glucose testing. We used multivariate regression models to compare Puerto Rico and the mainland United States, adjusted for age, income, race/ethnicity, and other demographic variables. FINDINGS: Uninsured rates were significantly lower in Puerto Rico (unadjusted 7.4% versus 15.0%, adjusted difference: -12.0%, p < 0.001). Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland United States to have a usual source of care and to have had a checkup within the past year, and fewer experienced cost-related delays in care. Screening rates for diabetes, mammograms, and Pap smears were comparable or better in Puerto Rico, while colonoscopy rates were lower. Self-reported health was slightly worse, but obesity and smoking rates were lower. CONCLUSIONS: Despite its far poorer population, Puerto Rico outperforms the mainland United States on several measures of coverage and access. Congressional policies capping federal Medicaid funds to the territory, however, have contributed to major budgetary challenges. While the ACA has significantly increased federal resources in Puerto Rico, ongoing restrictions on Medicaid funding and premium tax credits are posing substantial health policy challenges in the territory.
© 2015 Milbank Memorial Fund.
DOI: 10.1111/1468-0009.12138 PMCID: PMC4567854 PMID: 26350931 [Indexed for MEDLINE]
2. PLoS One. 2014 May 5;9(5):e96746. doi: 10.1371/journal.pone.0096746. eCollection 2014.
Effects of type of health insurance coverage on colorectal cancer survival in Puerto Rico: a population-based study.
Ortiz-Ortiz KJ(1), Ramírez-García R(2), Cruz-Correa M(3), Ríos-González MY(2), Ortiz AP(4).
Author information: (1)Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. (2)Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. (3)University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. (4)Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
Colorectal cancer represents a major health problem and an important economic burden in Puerto Rico. In the 1990's, the Commonwealth of Puerto Rico implemented a health care reform through the privatization of the public health system. The goal was to ensure access to health services, eliminate disparities for medically indigent citizens and provide special coverage for high-risk conditions such as cancer. This study estimates the 5-year relative survival rate of colorectal cancer and the relative excess risk of death in Puerto Rico for 2004-2005, by type of health insurance coverage; Government Health Plan vs. Non-Government Health Plan. Colorectal cancer in advanced stages was more common in Government Health Plan patients compared with Non-Government Health Plan patients (44.29% vs. 40.24 had regional extent and 13.58% versus 10.42% had distant involvement, respectively). Government Health Plan patients in the 50-64 (RR = 6.59; CI: 2.85-15.24) and ≥65 (RR = 2.4; CI: 1.72-4.04) age-groups had the greater excess risk of death compared with Non-Government Health Plan patients. Further studies evaluating the interplay of access to health services and the barriers affecting the Government Health Plan population are warranted.
DOI: 10.1371/journal.pone.0096746 PMCID: PMC4010542 PMID: 24796444 [Indexed for MEDLINE]
Conflict of interest statement: Competing Interests: The authors have declared that no competing interests exist.
3. Womens Health Issues. 2013 Sep-Oct;23(5):e273-80. doi: 10.1016/j.whi.2013.06.006.
Medicaid covered births, 2008 through 2010, in the context of the implementation of health reform.
Markus AR(1), Andres E, West KD, Garro N, Pellegrini C.
Author information: (1)Department of Health Policy, Jacobs Institute of Women's Health, School of Public Health and Health Services, The George Washington University, Washington, DC 20006, USA. armarkus@gwu.edu
Erratum in Womens Health Issues. 2013 Nov-Dec;23(6):e411.
BACKGROUND: Medicaid is a major source of public health care financing for pregnant women and deliveries in the United States. Starting in 2014, some states will extend Medicaid to thousands of previously uninsured, low-income women. Given this changing landscape, it is important to have a baseline of current levels of Medicaid financing for births in each state. This article aims to 1) provide up-to-date, multiyear data for all states, the District of Columbia, and Puerto Rico and 2) summarize issues of data comparability in view of increased interest in program performance and impact assessment. METHODS: We collected 2008-2010 data on Medicaid births from individual state contacts during the winter of 2012-2013, systematically documenting sources and challenges. FINDINGS: In 2010, Medicaid financed 45% of all births, an increase of 4% [corrected] in the proportion of all births covered by Medicaid in 2008. Percentages varied among states. Numerous data challenges were found. CONCLUSIONS/IMPLICATIONS FOR RESEARCH AND POLICY: Consistent adoption of the 2003 birth certificate in all states would allow the National Center for Health Statistics Natality Detail dataset to serve as a nationally representative source of data for the financing of births in the United States. As states expand coverage to low-income women, women of childbearing age will be able to obtain coverage before and between pregnancies, allowing for access to services that could improve their overall and reproductive health, as well as birth outcomes. Improved birth outcomes could translate into substantial cost savings, because the costs associated with preterm births are estimated to be 10 times greater than those for full-term births.
Copyright © 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.whi.2013.06.006 PMID: 23993475 [Indexed for MEDLINE]
4. J Psychiatr Pract. 2010 Mar;16(2):129-37. doi: 10.1097/01.pra.0000369975.95402.33.
The impact of managed care on psychiatric hospitalizations and length of stay in Puerto Rico.
Torres RR(1), Alegría M.
Author information: (1)Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico 00936-5067. rene.davila@upr.edu
The objective of this paper is to estimate the impact of managed care on psychiatric hospitalizations and length of stay of medically indigent residents in Puerto Rico. A quasi-experimental design and three waves of data from a random community sample were used. Results indicate that, after 2 years, managed care had minimal impact on the number of psychiatric hospitalizations; while the mean length of hospitalization decreased after implementation of managed care, this change was not significant. Based on the data in this study, the managed care initiative developed as part of health reform in Puerto Rico did not appear to affect rates of psychiatric hospitalization and produced only a nonsignificant reduction in the average length of psychiatric hospital stays. Additional research is needed to determine trends in mental health care provision in Puerto Rico based on more recent data.
DOI: 10.1097/01.pra.0000369975.95402.33 PMID: 20511738 [Indexed for MEDLINE]
5. Matern Child Health J. 2009 Mar;13(2):187-97. doi: 10.1007/s10995-008-0345-1. Epub 2008 May 17.
The effect of Medicaid managed care on prenatal care: the case of Puerto Rico.
Marín HA(1), Ramírez R, Wise PH, Peña M, Sánchez Y, Torres R.
Author information: (1)Puerto Rico Health Services Research Institute, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. hmarin@rcm.upr.edu.
OBJECTIVES: From 1994 to the year 2000 the government of Puerto Rico implemented a health care reform which included the mandatory enrollment of the entire Medicaid eligible population under Medicaid managed care (MMC) plans. This study assessed the effect of MMC on the use, initiation, utilization, and adequacy of prenatal care services over the reform period. METHODS: Using the vital records of all infants born alive in Puerto Rico from the year 1995-2000, a series of bivariate and multivariate analyses were conducted to assess the effect of insurance status (traditional Medicaid, MMC, private insurance and uninsured) on prenatal care utilization patterns. In order to assess the potential influence of selection bias in generating the health insurance assignments, propensity scores (PS) were estimated and entered into the multivariate regressions. RESULTS: MMC had a generally positive effect on the frequency and adequacy of prenatal care when compared with the experience of women covered by traditional Medicaid. However, the PS analyses suggested that self-selection may have generated part of the observed beneficial effects. Also, MMC reduced but did not eliminate the gap in the amount and adequacy of prenatal care received by pregnant women covered by Medicaid when compared to their counterparts covered by private insurance. CONCLUSIONS: The Puerto Rico Health Reform to implement MMC for pregnant women was associated with a general improvement in prenatal care utilization. However, continued progress will be necessary for women covered by Medicaid to reach prenatal care utilization levels experienced by privately insured women.
DOI: 10.1007/s10995-008-0345-1 PMID: 18484174 [Indexed for MEDLINE]
6. J Health Care Poor Underserved. 2007 Feb;18(1):116-38. doi: 10.1353/hpu.2007.0006.
Evaluation of breast cancer care under Puerto Rico's Health Care Reform.
Chirikos TN(1), López-Garcia J, Cintrón Vargas C, Gonzalez OL, Pérez-Grau MP, Baez-Diaz L.
Author information: (1)H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida, USA. chirikos@moffitt.usf.edu
Puerto Rico has implemented Health Care Reform legislation that shifted medically indigent and underserved persons from direct care by public sector institutions to managed care arrangements through the private sector. Our aim is to assess how previously underserved women with breast cancer have fared during the first three years of the Reform. Medical claims data were obtained on breast cancer cases in San Juan who were either enrolled in the capitated Reform plan or in a commercial policy offered by the same insurer. A set of indicators reflecting initial therapy, use of key services, and cumulative utilization rates of various medical procedures were constructed. Statistical tests were conducted to assess whether these indicators differed between Reform- and commercially-insured patients. Failure to reject null hypotheses of indicator differences were then used to judge Reform progress. We found some differences, but they were neither pervasive nor unidirectional. On balance, we conclude that previously underserved women are being treated for breast cancer roughly on par with other patients. This conclusion, however, is preliminary and subject to important qualifications.
DOI: 10.1353/hpu.2007.0006 PMID: 17337802 [Indexed for MEDLINE]
7. Rev Panam Salud Publica. 2005 Feb;17(2):92-101. doi: 10.1590/s1020-49892005000200005.
Changes in the AIDS epidemiologic situation in Puerto Rico following health care reform and the introduction of HAART.
Báez-Feliciano DV(1), Thomas JC, Gómez MA, Miranda S, Fernández DM, Velázquez M, Ríos-Olivares E, Hunter-Mellado RF.
Author information: (1)Universidad Central del Caribe, Retrovirus Research Center, Bayamón, Puerto Rico. dbaez@uccaribe.edu
OBJECTIVES: To compare the occurrence of AIDS as well as the sociodemographic and clinical profiles of AIDS patients in Puerto Rico before and after the introduction of highly active antiretroviral therapy (HAART) and the privatization of the island's public health care system. METHODS: We compared the incident AIDS cases for two three-year periods, 1992-1994 and 1998-2000, in four populations: (1) entire United States, (2) Puerto Rico, (3) Bayamón Health Region (located in north-central Puerto Rico, it includes 11 of the island's 78 municipalities), and (4) an HIV cohort enrolled at the Universidad Central del Caribe (UCC) School of Medicine. The UCC is located in Bayamón, Puerto Rico, within an academic medical complex that houses the teaching hospital (Ramón Ruíz Arnaú University Hospital), the ambulatory health care facilities (Immunology Clinics) for patients with HIV, and administrative buildings. This represents the major government-sponsored health care infrastructure within the Bayamón Health Region. RESULTS: Incident AIDS declined substantially between the two periods in each of the four populations studied. The 48.1% decline in Puerto Rico exceeded the 40.9% decline in the United States. The decline in Puerto Rico likely resulted from increased availability and implementation of HAART and the delivery of health care to HIV/AIDS patients in an integrated fashion within each regional ambulatory clinic. In spite of this improvement, the absolute number of patients with AIDS on the island remains high. Substantial resources for treatment and prevention are required. The proportion of new AIDS cases was lower among women, persons 40 years of age or older, the less educated, and those living alone. Injection drug use remains the predominant mode of transmission in Puerto Rico. CONCLUSIONS: Further gains in Puerto Rico's fight against AIDS will depend on the island's ability to reduce the transmission that occurs through injection drug use; the use of HAART on a larger number of vulnerable patients, particularly intravenous drug users; educational interventions to improve medication compliance in certain risk groups; and specific measures aimed at decreasing the rate of injection drug use.
DOI: 10.1590/s1020-49892005000200005 PMID: 15826386 [Indexed for MEDLINE]
8. Bol Asoc Med P R. 2003 Mar-Apr;95(2):30-7.
[Graduate medical education at the University of Puerto Rico Medical Sciences Campus confronting health care reform].
[Article in Spanish]
García-Palmieri MR(1).
Author information: (1)Escuela de Medicina, Universidad de Puerto Rico.
PMID: 14531198 [Indexed for MEDLINE]
9. Inquiry. 2001-2002 Winter;38(4):381-95. doi: 10.5034/inquiryjrnl_38.4.381.
The impact of managed care on the use of outpatient mental health and substance abuse services in Puerto Rico.
Alegría M(1), McGuire T, Vera M, Canino G, Freeman D, Matías L, Albizu C, Marín H, Calderón J.
Author information: (1)Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan 00936-5067, USA.
This paper estimates the impact of managed care on use of mental health services by residents of low-income areas in Puerto Rico. A quasi-experimental design evaluates the impact of a low capitation rate on a minority population using three waves of data from a random community sample. Results indicate that two years after introducing managed care, privatization of mental health services had minimal impact on use. Advocates had hoped health care reform would increase access in comparison to access seen within the public system, while opponents feared profit motives would lead to decreased access. Neither forecast turned out to be correct. The question remains as to how to improve access for the poor with low capitation rates.
DOI: 10.5034/inquiryjrnl_38.4.381 PMID: 11887956 [Indexed for MEDLINE]
10. P R Health Sci J. 2001 Jun;20(2):171-3.
[The diabetic patient and health care reform in Puerto Rico].
[Article in Spanish]
Ramírez-García R(1), Crespo-Rivera W.
Author information: (1)University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, Department of Health Service Administration, PO Box 365067, San Juan, Puerto Rico, 00936-5067.
PMID: 11561478 [Indexed for MEDLINE]
11. Am J Public Health. 2001 Sep;91(9):1431-4. doi: 10.2105/ajph.91.9.1431.
Changes in access to mental health care among the poor and nonpoor: results from the health care reform in Puerto Rico.
Alegría M(1), McGuire T, Vera M, Canino G, Matías L, Calderón J.
Author information: (1)Graduate School of Public Health, University of Puerto Rico, San Juan 00936-5067, USA. malegria@rcm.upr.edu
OBJECTIVES: Health care reforms associated with managed care may adversely affect the health care safety net for disadvantaged populations. This study compared changes in health care use among poor and nonpoor individuals enrolled in managed care. METHODS: Data from 3 waves of a random community sample were collected on approximately 3,000 adults. Changes in use of mental health services were assessed in a pretest-posttest, quasi-experimental design. RESULTS: Managed care increased use of specialty services among the nonpoor while maintaining the same level of use for the poor in the public sector. CONCLUSIONS: Reallocation of mental health services may be a result of expanding Medicaid eligibility.
DOI: 10.2105/ajph.91.9.1431 PMCID: PMC1446799 PMID: 11527776 [Indexed for MEDLINE]
12. P R Health Sci J. 2000 Sep;19(3):310-8.
[How to manage the quality and achieve the excellence in health services including the evaluation of the services as a instrument of improvement?].
[Article in Spanish]
Feliciano de Melecio C, Izquierdo Mora L, Rivera Dueño J, Vázquez Quintana E.
PMID: 11076379 [Indexed for MEDLINE]
13. J Allied Health. 2000 Spring;29(1):10-2.
Academic and ethical implications of health care reforms based on managed care: some critical reflections.
Santos y Vargas L(1).
Author information: (1)Eugenio María de Hostos Institute for Humanistic Studies and Bioethics, University of Puerto Rico, San Juan.
PMID: 10742949 [Indexed for MEDLINE]
14. J Allied Health. 2000 Spring;29(1):6-9.
Reinventing the delivery of health care services in Puerto Rico.
Rosselló P.
PMID: 10742948 [Indexed for MEDLINE]
15. P R Health Sci J. 1999 Dec;18(4):411-3.
Academic and ethical implications of health reforms based on managed care: some critical reflections.
Santos y Vargas L(1).
Author information: (1)Eugenio Maria de Hostos Institute for Humanistic Studies and Bioethics Medical Sciences Campus, University of Puerto Rico.
PMID: 10730311 [Indexed for MEDLINE]
16. P R Health Sci J. 1999 Sep;18(3):281-3.
The impact of the Puerto Rico Health Reform Act on graduate medical education.
Torres EA(1).
Author information: (1)Department of Medicine, University of Puerto Rico, San Juan 00936-5067, USA.
PMID: 10547874 [Indexed for MEDLINE]