Currently, 54% of Dominicans are registered under the subsidized regime (5,718,718 people), 45% under the contributory regime (4,704,115 citizens), and the remaining 1% (93,616 people) under the pension modality.

The specialist in Family Medicine made a historical account in which he stressed that Family Health Insurance was created to guarantee universal coverage of health services without exclusions. This includes promotion and prevention, patient rehabilitation, and coverage during pregnancy and postpartum.

It also gives the member the freedom to choose their Health Risk Manager (ARS) and the service provider where they will receive care.

In the event of loss of employment, the patient enjoys all the benefits for 60 days, and after these, his condition will be seen if he continues in the contributory regime or goes to the subsidized regime, where the unemployed and their families, people with disabilities, and those in a situation of destitution receive care.

According to Ramírez Slaibe, this is protected by Article 129 of Law 87-01 on Social Security, which establishes that all citizens have access to a Basic Health Plan, regardless of their social, labor, or economic status and the financial regime to which they belong.

Family Health Insurance came into operation in the Dominican Republic in 2002, and the contributory regime in 2007. Between 2020 and 2021, affiliation with the subsidized regime accelerated, incorporating more than two million people into Social Security, “going from 85% to 97% of the affiliated population we have today,” he said.

The system has 10,516,449 affiliates, and collections rose from 58,565,404,586.57 in its origins to 101,485,179,143.17 in 2024, practically doubling.

“The FSS has made significant progress in terms of health coverage and access in the Dominican Republic, but it continues to face significant challenges in equity, financing and quality of services,” he said.

The population of 46 to 60 years of age grows

According to the doctor, one aspect that is worrying is how age groups have been changing over the years. Today, there is a growth in the population between 46 and 60 years old, which, although it continues to contribute and be productive, is the next to move to the pension system.

“This situation leads to the need to rethink the redefinition of per capita,” he said.

Out-of-pocket expense

Regarding out-of-pocket spending, the director general of the Center for Research and Studies in Health Management explained that despite the fact that it was calculated at 61.24% in 2004 and at 42.2% in 2020, “the reduction has not been so significant,” taking into account inflationary rates.

He pointed out that the most frequent expenses are medicines, uncovered procedures, and co-payments.

Proposals and reforms

Ramírez Slaibe concluded his presentation, which was part of the workshop on Social Security and Health organized by the Social Security for All Foundation (FSSPT), by proposing proposals and reforms for the common welfare.

“The gap between the original design and the current reality reflects the need for profound reforms to ensure the sustainability of the system and guarantee the right to health of the entire population,” he said.

As a possible solution, he proposes reforming the Basic Health Plan, expanding coverage of essential medicines and high-cost treatments, strengthening primary care, and incorporating mental health and rehabilitation services.

Similarly, review the sources of financing of the Basic Plan, implementing the contributory-subsidized regime, which allows informal or unemployed collaborators to continue contributing. It also proposes to establish better cost control mechanisms.

The doctor requested that the network of providers be redesigned and more efficient referral mechanisms implemented, thus guaranteeing greater equitable access to health centers.

Finally, Ramírez Slaibe understands that, to achieve these objectives, a dialogue between the State, the actors of the health system, and civil society is necessary to build a “more efficient, equitable and sustainable” system.