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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Patricio Murgueytio, MD, PhD, REDSALUD Project, Abt Associates Inc., Calle Angel Severo Cabral No.31, Santo Domingo, Dominican Republic, 809-566-1586, dir.redsalud@codetel.net.do and Luis G. Morales, MD, MPH, REDSALUD Project, Development Associates, Inc., Calle Angel Severo Cabral No.31, Santo Domingo, Dominican Republic.
Health reform has been in the Dominican public policy agenda since the early 1990s, driven by systemic problems in its health care delivery system, inequity, and pressure by international lending institutions. In 1998 the Dominican Republic signed loan agreements with the World Bank and the Inter American Development Bank to implement an ambitious health reform program. Initially this program suffered several setbacks until August 2000 when the new government declared health a fundamental piece of its national strategy against poverty. In 2001 the Dominican congress approved two new laws in order to further institutionalize reforms. The new legal framework for health reform established a “managed competition” scheme together with national health insurance. Key features of this new framework include separation of functions, decentralization, competition, consumer choice, and mandatory social financing. Although the country has begun to set up the new system, the process must confront pockets of resistance, limited technical capacity, and pressures by local interest groups. Nonetheless, progress is evident as new institutions, such as the National Health Council, the National Social Security Council, and the Superintendent’s Office for Health and Labor Risks have been established and are operating. Regulations to define stakeholder roles, provider organization and management, and a health benefits package are under preparation. The prospect of a competitive environment challenges both the public and private sectors to enhance their service provider capacity with a clear focus on consumers. Thus, cautious optimism is warranted but leaders and key players must stay on course.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.