title: The Puerto Rico Healthcare Crisis.
abstract: The Commonwealth of Puerto Rico is an organized nonincorporated territory of the United States with a population of more than 3.5 million U.S. citizens. The island has been the focus of much recent attention due to the recent default on its debt (estimated at more than $70 billion), high poverty rates, and increasing unemployment. Less attention, however, has been given to the island's healthcare system, which many believe is on the verge of collapsing. Healthcare makes up 20% of the Puerto Rican economy, and this crisis affects reimbursement rates for physicians while promoting the disintegration of the island's healthcare infrastructure. A major contributor relates to a disparity in federal funding provided to support the island's healthcare system when compared with that provided to the states in the mainland and Hawaii. Puerto Rico receives less federal funding for healthcare than the other 50 states and the District of Columbia even though it pays its share of social security and Medicare taxes. To make matters worse, the U.S. Center for Medicaid and Medicare Services is planning soon to implement another 11% cut in Medical Advantage reimbursements. This disparity in support for healthcare is considered responsible for ∼$25 billion of Puerto Rico's total debt. The impact of these events on the health of Puerto Ricans in the island cannot be entirely predicted, but the loss of healthcare providers and diminished access to care are a certainty, and quality care will suffer, leading to serious implications for those with chronic medical disorders including respiratory disease.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville Health Sciences Center, and Robley Rex VA Medical Center, Louisville, Kentucky.
authors.forename: Jesse
authors.initials: J
authors.lastname: Roman
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D054625:Healthcare Disparities / Q000458:organization & administration*; D006801:Humans; D006278:Medicare / Q000458:organization & administration*; D011203:Poverty / Q000706:statistics & numerical data; D011647:Puerto Rico / Q000453:epidemiology; D014481:United States
keywords: Accountable Care Act; Center for Medicaid and Medicare Services; United States Territories; health care disparities; healthcare