The Dominican Republic is a high middle-income country, which has been experiencing the most important process of economic growth in Latin America and the Caribbean in recent decades, and has remained among the leaders in GDP growth of per capita.
The economic growth has been based on the ostensible advancement of the tourism industry which according to official estimates, directly explains about 25% of national value added. This average does not include the indirect effects on investment and the creation of new jobs. Tourism activities have, without doubt, a powerful impact on other economic sectors such as agriculture, industry, finance and public investments.
During year 2016, 6 million tourists arrived in the country, a figure higher by 400 thousand than in 2015, with the result that the country’s tourism income increased substantially compared to the previous year, to reach US $ 6.722 billion. The government has a plan to reach 10 million tourists by 2020, which seems feasible given the increase in private investment in the sector and the annual increase in hotel rooms, with a new 6,000 rooms expected in 2017.
The dynamism of tourism is evidenced by the persistent increase in the last decades of the number of hotel rooms, mainly due to increased foreign investment that has recognized the touristic attractions of the country and its institutional and macroeconomic stability.
The rapid expansion of the economy resulted in a substantial reduction in poverty (from 42.5% to 30.5%) between 2004 and 2016. Since year 2012, more than a million persons got out of poverty in the country. This has resulted in increasing life expectancy and the significant improvement in health indicators. It has also resulted in improved investment in health, a major expansion of its services and an improvement in the quality of the sector.
Given the greater linkages between technical staff in the sector and medical institutions in the United States, conditions have been created for giving a further boost to the development of the emerging medical tourism industry in the country.
The transformation of the health system — to be centered on people and to achieve universal coverage — has become one of the priorities of the national authorities. Just over a decade, the country adopted a structural reform of important magnitude, based on the separation of the functions of governance, financing and services. This occurred in an environment promoting the confluence of private and public actors in both the insurance and the provision of services, stimulating competition and facilitating investment.
The Family Health Insurance has implemented the following funding schemes with corresponding beneficiaries:
- Contributory scheme, that includes public and private salaried workers and employers. It is funded by workers and enterprises, including the State as an employer.
- Subsidized: for self-employed workers with unstable below the national minimum wage income as well as the unemployed, disabled and indigent. Funded by the Dominican State.
There is another regime which has never been implemented, the Subsidized Contributory Scheme to protect independent technical professionals and self-employed workers with average income above national minimum wage. There are presently discussions to modify the law in order to eliminate this regime.
Since 2007 when it began to expand the coverage of the new system, the affiliation of the population has grown dramatically, reaching 70% of the population in 2015. The government has plans to continue to give priority to this process, with the aim of achieving universal coverage by 2030.
The national health expenditure in 2015 amounted to around 5.8% of GDP. Although relatively low in the Latin American context, there is an explicit government policy to increase it by extending coverage of the family health insurance, providing the funds to cover the whole population entitled to the subsidized subsidized regime. The government also intends to promote the formalization of the Dominican economy, which simultaneously extends the coverage of the compulsory contribution.
Within the total financing to the sector, 48% of the funds are channeled through public funding schemes and 52% are private schemes. The latter include primarily direct payment from households to healthcare providers and the purchase of additional insurance or other private insurance, including international.
In the upper stratum of the healthcare market and primarily funded by private schemes, there are world-class services, closely linked to the American system. Some of these providers are already operating in tourist areas of the country, offering services to passively domestic visitors and others are developing an active strategy to serve customers who come to the country specifically to seek health services.
In terms of resources for health, there are more than 1,300 public establishments of various levels of care, with more than 12,000 beds, including 14 national referral hospitals. There is a large network of private sector providers, with more than 7,000 stores, within which it is estimated that more than 400 are private hospitals, 500 diagnostic centers and nearly 4,000 medical offices. The rest are pharmacies, vision centers, optical, etc.
Overall it is estimated that in 2013, the country had 2.1 physicians per 1,000 inhabitants and was the fourth in the LAC region with this number of professionals, indicator that is suitable for countries with a similar level of development. Although the number of nurses is below the international requirements, the Government has recently introduced measures to improve the conditions of remuneration and incentives, as well as the professionalism and quality of human resources at this level through virtual training focusing on guidelines and protocols of care. All this has improved in recent years, increasing investment in human resources, knowledge generation, information and technological tools. There have also made major investments in the construction, reconstruction and equipping of public facilities.
The government has been in the year 2016 carrying out important actions to reorganize the public health system, creating a unique network of public providers, improving management systems, strengthening primary care and agreeing on better working conditions and incentives for staff of health. A revision of the law on family health insurance is also underway to ensure that it offers better coverage of benefits and to extend protection to Dominican families.
The private sector is a fundamental partner in the Dominican health system. A high proportion of the use of services at the national level is carried out in the network of private providers, including all the population affiliated to the family health insurance contributory regime, plus people from the upper income strata, who pay with money from their own pocket and with international insurance.
In this sector, there is a group of providers run by world class managers with certified technology and human resources trained in developed countries, mainly in the United States. Given the proximity and traditional relations between the two countries, including a large Dominican population living in that country, many doctors specialize further and maintain close ties and frequent updating. There are diagnostic centers with the highest level and most advanced hospitals where the procedures are performed, as explained in the next section.
Advantages to receive health services in the Dominican Republic
The Dominican Republic has the most modern technology for diagnosis and treatment of various diseases, providing imaging equipment MRI of last generation, Pet Scan, computed tomography, minimally invasive procedures, micro surgery, organ transplantation, robotics surgery and health professionals trained in the United States and Europe.
The country has national quality policies in health and the government encourages the certification of all providers accordingly with national standards. Currently various institutions have memberships and international certifications such as ISO 9001 in its clinical laboratories and blood banks. The most important health centers in the country are in the process of international accreditation by Joint Commission International and Accreditation Canada International. They also have international departments responsible to facilitate the transfer, effective communication, translation services, treatment and continuity of health care for tourists.
Also, the country has several universities that train are foreign professionals, mainly from North America and have dual degree agreements with universities or the first world.
Some additional specific advantages of the Dominican Republic, which promote health tourism, are the following:
- Proximity and close ties with the United States and Canada
- Citizens of the United States, Canada and several European countries do not require visas
- There are numerous air links with all parts of the world, particularly in North and South America and Europe.
- Health centers accredited with first-order specialists.
- Immediate care without waiting lists
- Excellent road infrastructure and satellite communications.
- Favorable climate all year wound and sun and beach tourism, ideal for rest and recovery
- World-renowned anti-aging and spa wellness services
- Friendliness, warmth and hospitality of the Dominican staff, with respect to privacy
- Economic stability and security.